Current Status of the Open Abdomen Treatment for Intra-Abdominal Infection

Yuan, Yujie; Ren, Jianan; He, Yulong

doi:10.1155/2013/532013

Cited by 16 publications

(20 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The use of laparostomy in the management of intra‐abdominal sepsis remains controversial. Its use has been advocated in selected patients and shown to reduced mortality ; however, the risk of developing an ECF in these patients is thought to be high and our data support this, with 24 of the 29 patients managed with a long‐term open abdomen presenting with an ECF. Current ESCP guidelines on the prevention of acute IF recommend early fascial closure to help prevent the formation of ECF and IH and the results of this study support this recommendation .…”

Section: Discussionsupporting

confidence: 60%

Incisional hernia and enterocutaneous fistula in patients with chronic intestinal failure: prevalence and risk factors in a cohort of patients referred to a tertiary centre

et al. 2019

View full text Add to dashboard Cite

Aim This study aims to determine the prevalence of incisional hernia (IH) and enterocutaneous fistula (ECF) in patients with intestinal failure (IF) referred to a tertiary centre and to identify factors associated with their development. Method A retrospective case note review was undertaken of a prospectively maintained database of all patients on home parenteral nutrition between 2011 and 2016 at a UK tertiary referral centre for IF. Risk factors were identified using binary logistic regression. Results The database search identified 447 patients, of whom 349 (78.1%) had surgery prior to developing IF. Eighty‐one (23.2%) patients had an IH and 123 (35.2%) had an ECF at the time of referral. Of these, 51 (14.6%) had both IH and ECF. IH was associated with a high body mass index (P = 0.05), a history of a major surgical complication resulting in IF (P = 0.01), previous emergency surgery (P = 0.04), increasing number of operations (P = 0.02) and surgical site infection (SSI; P = 0.01). ECF was associated with complications relating to earlier surgery. (P ≤ .001), previous treatment with an open abdomen (P = 0.03), SSI (P = 0.001), intra‐abdominal collection (P ≤ 0.001) and anastomotic leak (P = 0.02). Conclusion In this series, patients with IF had a prevalence of IH which was more than double that expected following elective laparotomy (about 10%) and one in three had an ECF. Risk factors for IH and ECF are discussed.

show abstract

Section: Discussionsupporting

confidence: 60%

Incisional hernia and enterocutaneous fistula in patients with chronic intestinal failure: prevalence and risk factors in a cohort of patients referred to a tertiary centre

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The management of the OA can be safely achieved with acceptable outcomes but it remains expensive [ 21 ]. Its overuse may potentially lead to increased morbidity, of which enteroatmospheric fistulas are the most serious complication [ 22 ]. Compared with trauma patients, patients with abdominal sepsis have been described to have worse outcomes after OA, with increased incidence of fistula formation, intra abdominal abscesses, and a higher delayed primary closure rate [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper

et al. 2015

View full text Add to dashboard Cite

The open abdomen (OA) procedure is a significant surgical advance, as part of damage control techniques in severe abdominal trauma. Its application can be adapted to the advantage of patients with severe abdominal sepsis, however its precise role in these patients is still not clear.In severe abdominal sepsis the OA may allow early identification and draining of any residual infection, control any persistent source of infection, and remove more effectively infected or cytokine-loaded peritoneal fluid, preventing abdominal compartment syndrome and deferring definitive intervention and anastomosis until the patient is appropriately resuscitated and hemodynamically stable and thus better able to heal.However, the OA may require multiple returns to the operating room and may be associated with significant complications, including enteroatmospheric fistulas, loss of abdominal wall domain and large hernias.Surgeons should be aware of the pathophysiology of severe intra-abdominal sepsis and always keep in mind the option of using open abdomen to be able to use it in the right patient at the right time.

show abstract

“…Although it is one potential element of damage-control surgery, the current clinical guidelines do not recommend routine use of the open abdomen technique for secondary peritonitis [61,62]. While open-abdomen surgery prevents ACS development and allows a rapid and easy second look, it presents the risk of enteroatmospheric fistulas or fascial deviation [63]. The increased morbidity is furthermore based on physiologic changes, which are in line with persistent opening of the peritoneal cavity: hypothermia, impaired immune function, fluid loss, and increased muscle proteolysis must lead to the modification and adaptation of intensive care therapy (passive rewarming/air warmers, pain control, tailored ventilator support, monitoring of pH and lactate, etc.).…”

Section: Planned Relaparotomy Within 36-48 H 3 Open Abdomen Techniquementioning

confidence: 99%

Intra-abdominal sepsis: new definitions and current clinical standards

Hecker

Reichert

Reuß

et al. 2019

Langenbecks Arch Surg

View full text Add to dashboard Cite

Purpose The abdomen is the second most common source of sepsis and is associated with unacceptably high morbidity and mortality. Recently, the essential definitions of sepsis and septic shock were updated (Third International Consensus Definitions for Sepsis and Septic Shock, Sepsis-3) and modified. The purpose of this review is to provide an overview of the changes introduced by Sepsis-3 and the current state of the art regarding the treatment of abdominal sepsis. Results While Sepsis-1/2 focused on detecting systemic inflammation as a response to infection, Sepsis-3 defines sepsis as a lifethreatening organ dysfunction caused by a dysregulated host response to infection. The Surviving Sepsis Campaign (SSC) guideline, which was updated in 2016, recommends rapid diagnosis and initiating standardized therapy. New diagnostic tools, the establishment of antibiotic stewardship programs, and a host of new-generation antibiotics are new landmark changes in the sepsis literature of the last few years. Although the Bold^surgical source control consisting of debridement, removal of infected devices, drainage of purulent cavities, and decompression of the abdominal cavity is the gold standard of surgical care, the timing of gastrointestinal reconstruction and closure of the abdominal cavity (Bdamage control surgery^) are discussed intensively in the literature. The SSC guidelines provide evidence-based sepsis therapy. Nevertheless, treating critically ill intensive care patients requires individualized, continuous daily re-evaluation and flexible therapeutic strategies, which can be best discussed in the interdisciplinary rounds of experienced surgeons and intensive care medicals.

show abstract

Current Status of the Open Abdomen Treatment for Intra-Abdominal Infection

Cited by 16 publications

References 52 publications

Incisional hernia and enterocutaneous fistula in patients with chronic intestinal failure: prevalence and risk factors in a cohort of patients referred to a tertiary centre

Incisional hernia and enterocutaneous fistula in patients with chronic intestinal failure: prevalence and risk factors in a cohort of patients referred to a tertiary centre

The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper

Intra-abdominal sepsis: new definitions and current clinical standards

Contact Info

Product

Resources

About