Open abdomen in gastrointestinal surgery: Which technique is the best for temporary closure during damage control?

Ribeiro, Marcelo Augusto Fontenelle; Barros, Emily Alves; Carvalho, Sabrina Marques De; Nascimento, Vinícius Pereira; Neto, José Cruvinel; Fonseca, Alexandre Zanchenko

doi:10.4240/wjgs.v8.i8.590

Cited by 19 publications

(12 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Different TAC techniques have different rates of postoperative complications. One RCT showed that VSD-assisted TAC did not cause intestinal fistulas, 93 and a review suggested that VSD was better than the Bogota bag and Barker techniques in reducing complications and infection rates 106 …”

Section: Recommendationsmentioning

confidence: 99%

Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries—Update and systematic review

Sun

et al. 2019

Chinese Journal of Traumatology

View full text Add to dashboard Cite

Vacuum sealing drainage (VSD) is frequently used in abdominal surgeries. However, relevant guidelines are rare. Chinese Trauma Surgeon Association organized a committee composed of 28 experts across China in July 2017, aiming to provide an evidence-based recommendation for the application of VSD in abdominal surgeries. Eleven questions regarding the use of VSD in abdominal surgeries were addressed: (1) which type of materials should be respectively chosen for the intraperitoneal cavity, retroperitoneal cavity and superficial incisions? (2) Can VSD be preventively used for a high-risk abdominal incision with primary suture? (3) Can VSD be used in severely contaminated/infected abdominal surgical sites? (4) Can VSD be used for temporary abdominal cavity closure under some special conditions such as severe abdominal trauma, infection, liver transplantation and intra-abdominal volume increment in abdominal compartment syndrome? (5) Can VSD be used in abdominal organ inflammation, injury, or postoperative drainage? (6) Can VSD be used in the treatment of intestinal fistula and pancreatic fistula? (7) Can VSD be used in the treatment of intra-abdominal and extra-peritoneal abscess? (8) Can VSD be used in the treatment of abdominal wall wounds, wound cavity, and defects? (9) Does VSD increase the risk of bleeding? (10) Does VSD increase the risk of intestinal wall injury? (11) Does VSD increase the risk of peritoneal adhesion? Focusing on these questions, evidence-based recommendations were given accordingly. VSD was strongly recommended regarding the questions 2–4. Weak recommendations were made regarding questions 1 and 5–11. Proper use of VSD in abdominal surgeries can lower the risk of infection in abdominal incisions with primary suture, treat severely contaminated/infected surgical sites and facilitate temporary abdominal cavity closure.

show abstract

Section: Recommendationsmentioning

confidence: 99%

Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries—Update and systematic review

Sun

et al. 2019

Chinese Journal of Traumatology

View full text Add to dashboard Cite

show abstract

“…A Echo-FAST was performed where abundant free fluid was observed in all the quadrants, being transferred to the operating room for an emergency laparotomy, evidencing a 4-liter hemoperitoneum secondary to an active arterial bleeding from a complete avulsion of the hepatic artery itself as well as multiple hepatic lacerations. The patient remained unstable throughout surgery, requiring massive transfusion and vasoactive agents, thus we decided to ligate the proper hepatic artery and perform temporary abdominal closure using the vacuum pack technique [5].…”

Section: Case Presentationmentioning

confidence: 99%

Liver transplantation following hepatic artery avulsion in a trauma patient

Cepedal

Mateo

Prieto

et al. 2019

Journal of Surgical Case Reports

View full text Add to dashboard Cite

Background Hepatic artery avulsion following politrauma is an extremely rare condition with a very high mortality rate. Management is based on damage control surgery given the precarious situation of these patients. Ligating the artery is one option under such circumstances, despite potential consequences including ischemic cholangiopathy (IC). Ischemic cholangiopathy, which can be caused by an insufficient blood supply to the bile duct, generally results in stricture and recurrent cholangitis, and the need for a liver transplant in extreme cases. Case presentation We present the case of a 37-year-old male with multiple traumas after falling from the third floor of a building. He was hemodynamically unstable upon arrival at the emergencies department, with no improvement on administration of aggressive fluid therapy. A Echo-FAST exam evidenced fluid in all quadrants, so the patient was transferred to the operating room where a 4-litre hemoperitoneum secondary to total avulsion of the proper hepatic artery was observed. The patient required massive transfusion and vasoactive drugs, with instability throughout the intervention; therefore, we decided to ligate the proper hepatic artery. Hepatic dysfunction and diffuse IC with multiple episodes of recurrent cholangitis were observed during the postoperative period. Given the irreversible clinical picture, we opted for a liver transplant 70 days after the patient’s initial admission. The patient died on Day 34 post-transplant due to irreversible ischemic brain damage and a right occipital hemorrhage. Conclusions Hepatic artery avulsion due to trauma is very rare and its management very complex, and in certain situations the artery must be ligated. The main consequence of ligating the hepatic artery is IC, which is more frequently observed secondary to iatrogenic lesions or systemic diseases, while very few cases have been published in which IC is secondary to hepatic artery avulsion caused by hepatic trauma. Treatment depends on the extent of ischemia, and when the damage is diffuse, as in our case, it may involve a liver transplant.

show abstract

“…In Bogota bag method; as it has been reported in previous studies, necrotic tissues were removed, perforations were repaired, the abdomen was washed and aspirated, drain was placed into the abdomen via laparotomy in the operation room every 48-72 hours, and sterile nutrition or urinary flush bags were attached to the fascia one by one with nonabsorbable suture. [6] In this group, if the fascia of the patient was close enough, the final closure was performed with primary closure, but if the fascia was stretched, onlay nonabsorbable graft was placed on to the fascia, and the fascia was pressed medially in every 3 days. If the fascia could not be closed completely, closure was achieved either by undersizing or by trimming the graft.…”

Section: Surgical Techniquementioning

confidence: 99%

The Effects of Temporary Closure Methods on Mortality and Morbidity in Patients with Open Abdomen

Kılıç

Uğur²,

Yetim³

et al. 2018

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

show abstract

Open abdomen in gastrointestinal surgery: Which technique is the best for temporary closure during damage control?

Abstract: The VAC technique, showed to be superior allowing a better control of liquid on the third space, avoiding complications such as fistula with small mortality, low infection rate, and easier capability on primary closure of the abdominal cavity.

Cited by 19 publications

References 30 publications

Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries—Update and systematic review

Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries—Update and systematic review

Liver transplantation following hepatic artery avulsion in a trauma patient

The Effects of Temporary Closure Methods on Mortality and Morbidity in Patients with Open Abdomen

Contact Info

Product

Resources

About