Long-Term Physical, Mental, and Functional Consequences of Abdominal Decompression

Abstract

Abdominal decompression with skin grafting and delayed fascial closure initially decreases patient perception of physical, social, and emotional health, but subsequent abdominal wall reconstruction restores physical and mental health to that of the U.S. general population. Abdominal decompression does not prevent return to gainful employment and should not be considered a permanently disabling condition.

The impact of a massive transfusion protocol (1:1:1) on major hepatic injuries: Does it increase abdominal wall closure rates?

“…Although these abdomens are covered by a skin graft, the short and longterm morbidity, economic and resource cost are substantial and mortality is high. [32][33][34][35]50 The abdominal wall closure rate associated with the implementation of a 1:1:1 MTP was higher than in patients who received a low plasma massive transfusion (67% v. 27%) despite the use of similar intraoperative techniques. While these rates did not vary in patients with either grade 3 or 5 liver trauma, a large improvement was noted in patients with grade 4 injuries (14% v. 89%; Table 3).…”

“…28,29,31 Unfortunately, the resultant "open" abdomen remains fraught with considerable short and long-term morbidity. [31][32][33][34][35] In the best case scenario this includes a poor quality of life and the need for major reconstructive surgery. [32][33][34][35] In addition to its effect on acidosis and coagulopathy, MTPs have also been shown to substantially reduce the volume of crystalloid fluid delivered during the initial resuscitation period.…”

“…[31][32][33][34][35] In the best case scenario this includes a poor quality of life and the need for major reconstructive surgery. [32][33][34][35] In addition to its effect on acidosis and coagulopathy, MTPs have also been shown to substantially reduce the volume of crystalloid fluid delivered during the initial resuscitation period. 1,15,17 Uncontrolled/excessive resuscitation is a clear risk factor for the development of ACS as well as a major obstacle to obtaining definitive fascial closure of the abdominal wall (visceral edema).…”

Damage control resuscitation: history, theory and technique

“…Unfortunately, the open abdomen is also responsible for significant short-term (fluid and protein loss, sepsis, intestinal fistulae, nursing care challenges, economic costs) and long-term (chronic physical discomfort, physique embarrassment, delayed return to work, poor quality of life) morbidity. [57][58][59][60] Several techniques for covering the open abdomen at the index operation are available (Box 1). Because no single technique has been shown to be superior to others, a given trauma centre should use a single consistent option that ensures familiarity among all surgeons, house staff and nurses.…”

Identifying patients at risk for high-grade intra-abdominal hypertension following trauma laparotomy

“…Surgeons can consider using TAC 5 following trauma laparotomy when a patient is likely to develop IAH or ACS. However, a prolonged open abdomen is associated with higher morbidity including intra-abdominal infections, sepsis, anastomotic leakage, intestinal fistulae and sepsis (10)(11)(12)(13). Knowledge of specific risk factors for IAH or ACS following trauma laparotomy may help the surgeon to mitigate these risks and improve outcomes.…”