Abstract
Open abdomen (OA) is a condition in which at the end of laparotomy, performed whether for trauma or for non-trauma surgical emergencies, the fascial edges are left purposefully open, in order to avoid the increase of intra-abdominal pressure (IAP) and the onset of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS), to allow abdominal planned re-exploration(s) (PR), or to manage intra-abdominal infections, in a stepwise approach. This strategy induces dramatic changes in patient’s physiology and may render the patient prone to the onset of complications, such as development of the entero-atmospheric fistula. Due to the complexity of this peculiar clinical setting, doctors who treat OA patients must be aware about the correct indications at the indicative laparotomy, technical elements for temporary abdominal closure (TAC), strategies for fistula takedown, and definitive reconstruction of the abdominal wall, in addition to the elements of critical care. This chapter, written by authors with a wide experience in the management of OA patients, is an updated and concise but comprehensive overview encompassing all the technical aspects of the problem, and it may represent a useful tool for all surgeons, intensivists, and nurses who take care of patients with an open abdomen.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Chiara O, Cimbanassi S, Biffl W, et al. International consensus conference on open abdomen in trauma. J Trauma Acute Care Surg. 2016;80:173–83.
Rotondo MF, Schwab CW. Damage control: an approach for improved survival in exsanguinating penetrating abdominal trauma. J Trauma. 1993;45:914–21.
Van Ruler O, Mahler CV, Boer KR, et al. Comparison of on-demand vs planned relaparotomy in patients with severe peritonitis. A randomized trial. JAMA. 2007;298:865–72.
Cheatham ML, Malbrain MNG, Kirkpatrick A, et al. Results from international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. II recommendations. Intensive Care Med. 2007;33:951–62.
Bjorck M, Bruhin A, Cheatham M, et al. Classification important step to improve management of patients with an open abdomen. World J Surg. 2009;33:1154–7.
Kirkpatrick AW, Roberts DJ, De Waele JD, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39:1190–206.
Bjorck M, Kirkpatrick AW, Cheatham M, et al. Amended classification of the open abdomen. Scand J Surg. 2016;105:5–10.
Bjarnason T, Montgomery A, Acosta S, et al. Evaluation of the open abdomen classification system: a validity and reliability analysis. World J Surg. 2014;38:3112–24.
Kafka-Ritsch R, Zitt M, Schorn N, et al. Open abdomen treatment with dynamic sutures and topical negative pressure resulting in a high primary fascial closure rate. World J Surg. 2012;36:1765–71.
Chiara O, Cimbanassi S, Negreanu J. Methods for temporary abdominal closure. In: Chiara O, Cimbanassi S, editors. Atlas of open abdomen in trauma-how I do it. Minerva Medica; 2017. p. 11–8.
Ryczerc AM, Slack P, McNulty AK. Distribution assessment comparing continuous and periodic wound instillation in conjunction with negative pressure wound therapy using an agar-based model. Int Wound J. 2013;10:214–20.
Roberts DJ, Zygun DA, Grendar J, et al. Negative pressure wound therapy for critically ill adults with open abdominal wound: a systematic review. J Trauma Acute Care Surg. 2012;73:629–39.
Vargo D, Richardson D, et al. Management of the open abdomen: from initial operation to definitive closure. Am Surg. 2009;75:S1–S22.
Keramati M, Srivastava A, Sakabu S, et al. The Wittmann patch™ as a temporary abdominal closure device after decompressive celiotomy for abdominal compartment syndrome following burns. Burns. 2008;34:493–7.
Barker DE, Kaufman HJ, Smith LA, et al. Vacuum pack technique of temporary abdominal closure: a 7-years experience with 112 patients. J Trauma. 2000;48:201–6.
Rasilainen SK, Mentula PJ, Leppaniemi AK. Vacuum and mesh-mediated fascial traction for primary closure of the open abdomen in critically ill surgical patients. Br J Surg. 2012;99:1725–32.
Lindstedt S, Malmsjo M, Helbowicz J, et al. Comparative study of microvascular blood flow in the intestinal wall, wound contraction and fluid evacuation during negative pressure therapy in laparostomy using V.A.C abdominal dressing and ABThera™ open abdomen negative pressure therapy system. Int Wound J. 2013;10:411–7.
Patel NY, Cogbill TH, Kallies KJ, et al. Temporary abdominal wall closure: long term outcomes. J Trauma. 2011;65:337–42.
Ouellet JF, Ball CG. Recurrent abdominal compartment syndrome induced by high negative pressure abdominal closure dressing. J Trauma. 2011;71:785–6.
Wainstein DE, Tungler V, Ravazzola C, et al. Management of external small bowel fistulae. Challenges and controversies confronting the general surgeon. Int J Surg. 2011;9:198–203.
Chiara O, Cimbanassi S. Entero-atmospheric fistula(s). In: Chiara O, Cimbanassi S, editors. Atlas of open abdomen in trauma-how I do it. Minerva Medica; 2017. p. 26–40.
Subramanian MH, Liscum KR, Hirshberg A. The floating stoma: a new technique for controlling exposed fistula in abdominal trauma. J Trauma. 2005;53:386–8.
Layton B, DuBose J, Nichols S, et al. Pacifying the open abdomen with concomitant intestinal fistula: a novel approach. Am J Surg. 2010;190:e48–50.
Jannasch O, Chiapponi C, Tautenhahn J, et al. The fistula adapter, an evolving device in treatment of entero-atmospheric fistulae. Negat Pressure Wound Ther. 2014;1:112–4.
Goverman J, Yelon JA, Platz JJ, et al. The “Fistula VAC”, a technique for management of enterocutaneous fistula arising within the open abdomen: a report of 5 cases. J Trauma. 2006;60:428–31.
Ramsay PT, Mejia VA. Management of entero-atmospheric in the open abdomen. Am Surg. 2010;76:637–9.
Verhaalen A, Walkins B, Brasel K. Techniques and cost effectiveness of enteroatmospheric fistula isolation. Wounds. 2010;22:212–7.
Ramirez OA, Ruas E, Dellon AL. “Component separation” method for closure of abdominal wall defects: an anatomic and clinical study. Plast Reconstruct Surg. 1990;86:519–26.
Burlew CC, Moore EE, Biffl WL, et al. One hundred percent fascial approximation can be achieved in the postinjury open abdomen with a sequential closure protocol. J Trauma. 2012;72:235–41.
Salman AE, Yetisir F, Aksoy M, et al. Use of dynamic closure system in conjunction with vacuum assisted closure therapy in delayed closure of open abdomen. Hernia. 2014;18:99–104.
Pauli EM, Rosen MJ. Open ventral hernia repair with component separation. Surg Clin North Am. 2013;93:1111–3.
Tukiainen E, Leppaniemi A. Reconstruction of extensive abdominal wall defects with microvascular tensore fascia latae flap. Br J Surg. 2011;98:880–4.
Cimbanassi S, Lippi, M, Chiara O. Intensive care management of the open abdomen patient. In: Chiara O, Cimbanassi S, editors. Atlas of open abdomen in trauma-how I do it. Minerva Medica; 2017. p. 50–66.
Malbrain M, De Laet E. Intra-abdominal hypertension: evolving concepts. Clin Chest Med. 2009;30:45–70.
Koehl R. Intra-abdominal hypertension and abdominal compartment syndrome. Crit Care Nurse. 2012;32:19–32.
De Waele JJ, De L, De Keulenaer B, et al. The effect of different reference transducer positions on intra-abdominal pressure measurement. A multicenter analysis. Intensive Care Med. 2008;34:1299–303.
Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in intensive care unit. N Engl J Med. 2004;350:2247–56.
Rossaint R, Bouillon B, Cerny V, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Crit Care. 2016;20:100–55.
Veigas PV, Callum J, Rizoli S, et al. A sustematic review on the rotational thromboelastometry (ROTEM®) values for the diagnosis of coagulopathy, prediction and guidance of blood transfusion and prediction of mortality in trauma patients. Scand J Trauma Resusc Emerg Med. 2016;24:114–28.
Cortes-Puentes GA, Gard KE, Adams AB, et al. Value and limitations of transpulmonary pressure calculations during intra-abdominal hypertension. Crit Care Med. 2013;41:1632–7.
Guerrero M, Cannizzo F, Falta E, et al. Prone ventilation in a United State Marine with acute respiratory distress syndrome and open abdominal injury. South Med J. 2009;102:637–9.
Mehta S, Burry L, Martinez-Motta JC, et al. A randomized trial of daily awakening in critically ill patients managed with a sedation protocol: a pilot trial. Crit Care Med. 2008;36:2092–9.
Payen JF, Chanques G, Mantz J, et al. Current practices in sedation and analgesia for mechanical ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology. 2007;107:858–60.
Memis D, Inal MT, Kavalci G, et al. Intravenous paracetamol reduced the use of opioids, extubation time, and opioid-related adverse effects after major surgery in intensive care unit. J Crit Care. 2010;25:458–62.
Barr J, Fraser GL, Puntillo KL, et al. Clinical practice guidelines for the management of pain, agitation and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41:263–306.
Girard TD, Pandharipande PP, Carson SS, et al. Feasibility, efficacy, and safety of antipsychotic for intensive care unit delirium: the MIND randomized, placebo-controlled trial. Crit Care Med. 2010;38:428–37.
Cheatham ML, Safsak K, Brzezinski SJ, et al. Nitrogen balance, protein loss and the open abdomen. Crit Care Med. 2007;35:127–31.
Majercik S, Kinikini M, White T. Enteroatmospheric fistula: from soup to n uts. Nutr Clin Pract. 2012;27:507–12.
Dutton WD, Diaz JJ Jr, Miller RS. Critical care issues in managing complex open abdominal wound. J Intensive Care Med. 2012;27:161–7.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Cimbanassi, S., Chiara, O. (2019). Open Abdomen: Indications, Surgical Management, and Critical Care. In: Aseni, P., De Carlis, L., Mazzola, A., Grande, A.M. (eds) Operative Techniques and Recent Advances in Acute Care and Emergency Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-95114-0_43
Download citation
DOI: https://doi.org/10.1007/978-3-319-95114-0_43
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-95113-3
Online ISBN: 978-3-319-95114-0
eBook Packages: MedicineMedicine (R0)