Myths and realities in the management of the open abdomen with negative pressure systems. A case report and literature review

Abstract

Highlights The open abdomen is a useful resource for treating patients with abdominal hypertension and abdominal compartment syndrome. Multiple techniques have been described in the literature. Adequate application of negative pressure therapy in combination with fascial retraction, has proved to be the most convenient approach in the management of the open abdomen.

Terapia por pressão subatmosférica de baixo custo como alternativa para fechamento abdominal temporário em hospital público: relato de caso

“…An improvement tendency was observed in the primary fascial closure and a longer survival in patients with open abdomen were observed in those submitted to temporary abdominal closure with commercial or noncommercial vacuum dressing 13,14 . Although better results are observed with commercial kits, this fact does not prevent the use of the modified Barker technique in places of few financial resources as a great alternative to temporary abdominal closure 10 .…”

“…Although the modified vacuum dressing presents more expensive values and materials for its manufacture, compared to the treatment with the Bogota bag, there is benefit in its use. These values are compensated by saving nursing work hours by dressing changes, reduction of hospitalization time and ineffectiveness of previous treatments, since there is savings of several daily changes of secondary dressings (gauze, compresses, adhesives) drenched by exudate and effectiveness in treatment with sub atmospheric pressure 1,4,7,14 .…”

Abdominal Negative Pressure Wound Therapy Devices for Management of the Open Abdomen

“…Negative therapy should be maintained on the continuous setting to provide constant support and tension to abdominal fascia, facilitate approximation, and help prevent displacement of protective layer over intestinal loops 1,9…”

“…1 Specifically, a laporostomy is performed and the fascial edges of the rectus abdominus muscles are intentionally left unapproximated to prevent further complications and facilitate surgical reexploration as indicated. 2 The OA approach has been employed for a variety of conditions including abdominal trauma, 1,3 shock, 1 intestinal edema following excessive resuscitation, 1,2,4 intra-abdominal infections/ peritonitis, [1][2][3] and severe pancreatitis. 1,2 The OA approach benefits patients at risk for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) by avoiding increased intra-abdominal pressure, which can interfere with blood flow.…”

“…The concept of the open abdomen (OA) was first described as a management for patients with secondary peritonitis in 1987 by Andrew McCosh. 1 Specifically, a laporostomy is performed and the fascial edges of the rectus abdominus muscles are intentionally left unapproximated to prevent further complications and facilitate surgical reexploration as indicated. 2 The OA approach has been employed for a variety of conditions including abdominal trauma, 1,3 shock, 1 intestinal edema following excessive resuscitation, 1,2,4 intra-abdominal infections/ peritonitis, [1][2][3] and severe pancreatitis.…”