Temporary closure of the abdominal wall (laparostomy)

Abstract

The definitive closure of the abdominal wall, i.e., a closure of the fascial layer and skin may not be favorable in the treatment of numerous surgical conditions, e.g., peritonitis, trauma, or mesenteric ischemia. In these cases, the abdominal wall is temporarily closed, and a laparostomy is created to facilitate re-exploration or to prevent abdominal compartment syndrome. Regarding the technique and material used for the temporary closure, no prospective randomized data exists, but mesh materials are commonly used. They provide drainage of infectious material, permit visual control of the underlying viscera, facilitate access to the abdominal wall, preserve the fascial margin, enable healing by secondary intention, and allow mobilization of the patient. In the case of decreasing intra-abdominal pressure, meshes can be trimmed to centralize the rectus muscle and to facilitate definitive closure. Non-absorbable meshes have been frequently reported to cause enteric fistulae and persistent infection necessitating mesh explantation. While these infectious complications appear to occur less frequently with the use of absorbable materials, these meshes will finally lead to an incisional hernia, requiring repair with non-absorbable mesh after a period of 6-12 months. Nevertheless, in the complex situation requiring a temporary abdominal wall closure, use of absorbable mesh material is common and represents the state of the art.

Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis

“…For more sufficient prevention of IAH, a zipper has been combined with mesh for temporary abdominal closure in cases of complicated IAS Table 2 -Table 2 -Table 2 -Table 2 -Table 2 Utiyama Utiyama Utiyama Utiyama Utiyama Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis due to intestinal perforation or anastomosis dehiscence; this approach was proposed by Hedderich et al 16 in the USA and by Teichmann et al,in Germany 31 . Although this device allows easy access to the abdominal cavity, mandatory exploration prior to wound closure or healing appears disadvantageous 32 . The indications for zip closure treatment remain debatable.…”

Prospective Assessment of the Negative Pressure Wound Therapy of the Open Abdomen

“…[21][22][23] As more than 90% of fistulas are of iatrogenic origin, with their increasing incidence rate hand in hand with the prolongation of definite closure of OA, [21][22][23] the closure of OA should be performed as soon as possible. Even though there are debates over increased fistula rates in patient with OA managed by NPWT, 24 our latest paper did not support this opinion.…”

“Acute postoperative open abdominal wall”: Nosological concept and treatment implications

“…Other techniques for progressive closure of the abdominal wall, in combination or not with NPWT, include dynamic wound closure systems based on continuous dynamic tension to achieve re-approximation of the fascial edges of the abdominal wall [29,30] or the use of patches of synthetic material as a temporary, gradual means for abdominal closure [31] ; (3) Patients beyond the 2-3 wk window without progress towards closure or improvement of general condition and interstitial edema ("frozen abdomen") and without bowel fistulization. In these cases, the treatment options include skin cover over the defect or allow wound granulation (absorbable synthetic mesh implant, NPWT) and thereafter cover with skin grafts and subsequent definitive delayed closure (after 6-12 mo) in the context of a "planned" incisional hernia repair [32][33][34][35][36][37] ; and (4) Patients with enteroatmospheric fistula. In these cases, the constant leak of enteric contents on the open abdomen aggravates the inflammation and encourages the formation of new fistulas.…”