Fascial closure after open abdomen: Initial indication and early revisions are decisive factors – A retrospective cohort study

Lambertz, Andreas; Mihatsch, Ch; Röth, A; Kalverkamp, Sebastian; Eickhoff, Roman; Neumann, Ulf; Klink, Christian D.; Junge, K.

doi:10.1016/j.ijsu.2014.11.025

Cited by 31 publications

(25 citation statements)

References 29 publications

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“…This suggests that, if the ultimate goal is to close the abdomen, an initial decision to leave the abdomen open may be strategically beneficial (compared with initial closure followed by relaparotomy on demand). Early (as opposed to delayed) second‐ and (where required) third‐look laparotomy were also associated with higher rates of fascial closure, which appeared to be associated with lower hospital mortality.…”

Section: Surgerymentioning

confidence: 93%

Recent developments in the surgical management of complex intra-abdominal infection

Soop

Carlson

2017

British Journal of Surgery

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Background: Current guidance on the management of sepsis often applies to infection originating from abdominal or pelvic sources, which presents specific challenges and opportunities for efficient and rapid source control. Advances made in the past decade are presented in this article.Methods: A qualitative systematic review was undertaken by searching standard literature databases for English-language studies presenting original data on the clinical management of abdominal and pelvic complex infection in adults over the past 10 years. High-quality studies relevant to five topical themes that emerged during review were included.Results: Important developments and promising preliminary work are presented, relating to: imaging and other diagnostic modalities; antimicrobial therapy and the importance of antimicrobial stewardship; the particular challenges posed by fungal sepsis; novel techniques in percutaneous and endoscopic source control; and current issues relating to surgical source control and managing the abdominal wound. Logistical challenges relating to rapid access to cross-sectional imaging, interventional radiology and operating theatres need to be addressed so that international benchmarks can be met.

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Section: Surgerymentioning

confidence: 93%

Recent developments in the surgical management of complex intra-abdominal infection

Soop

Carlson

2017

British Journal of Surgery

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“…No major technical difficulties are described to obtain primary fascial closure within few days from the index operation. Patients having abdominal sepsis are less likely to achieve an early fascial closure [ 119 ] and therefore should have closure attempts performed as soon as possible after severe abdominal sepsis is controlled [ 120 ].…”

Section: Methodsmentioning

confidence: 99%

The role of open abdomen in non-trauma patient: WSES Consensus Paper

et al. 2017

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The open abdomen (OA) is defined as intentional decision to leave the fascial edges of the abdomen un-approximated after laparotomy (laparostomy). The abdominal contents are potentially exposed and therefore must be protected with a temporary coverage, which is referred to as temporal abdominal closure (TAC). OA use remains widely debated with many specific details deserving detailed assessment and clarification. To date, in patients with intra-abdominal emergencies, the OA has not been formally endorsed for routine utilization; although, utilization is seemingly increasing. Therefore, the World Society of Emergency Surgery (WSES), Abdominal Compartment Society (WSACS) and the Donegal Research Academy united a worldwide group of experts in an international consensus conference to review and thereafter propose the basis for evidence-directed utilization of OA management in non-trauma emergency surgery and critically ill patients. In addition to utilization recommendations, questions with insufficient evidence urgently requiring future study were identified.

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“…Primary fascial closure can be achieved in many cases within few days from the initial operation without technical difficulties. Patients having abdominal sepsis are less likely to achieve an early fascial closure [ 49 ] it should be performed as soon as possible after severe abdominal sepsis is controlled [ 50 ].…”

Section: Management Of Patients With Open Abdomenmentioning

confidence: 99%

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

et al. 2015

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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.

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Fascial closure after open abdomen: Initial indication and early revisions are decisive factors – A retrospective cohort study

Abstract: The probability to reach fascial closure after open abdomen seems to increase when open abdomen is performed initially and when early second and third look operations are performed. The presence of pancreatitis seems to be the only negative prognostic marker concerning fascial closure.

Cited by 31 publications

References 29 publications

Recent developments in the surgical management of complex intra-abdominal infection

Recent developments in the surgical management of complex intra-abdominal infection

The role of open abdomen in non-trauma patient: WSES Consensus Paper

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

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