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

Catena, Fausto; Montori, Giulia; Ceresoli, Marco; Catena, Fausto; Moore, Ernest E.; Ivatury, Rao R.; Biffl, Walter L.; Peitzman, Andrew B.; Coimbra, Raúl; Rizoli, Sandro; Kluger, Yoram; Abu‐Zidan, Fikri M.; Sartelli, Massimo; Moya, Marc de; Velmahos, George C.; Fraga, Gustavo Pereira; Pereira, Bruno M.; Leppäniemi, Ari; Boermeester, Marja A.; Kirkpatrick, Andrew W.; Maier, Ron; Bala, Miklosh; Sakakushev, Boris; Khokha, Vladimir; Malbrain, Manu L N G; Agnoletti, Vanni; Martín‐Loeches, Ignacio; Sugrue, Michael; Saverio, Salomone Di; Griffiths, Ewen A.; Søreide, Kjetil; Mazuski, John E.; May, Addison K.; Montravers, Philippe; Melotti, Rita Maria; Pisano, Michele; Salvetti, F; Marchesi, Gianmariano; Valetti, Tino Martino; Scalea, Thomas M.; Chiara, Osvaldo; Kashuk, Jeffry L.; Ansaloni, Luca

doi:10.1186/s13017-017-0146-1

Cited by 94 publications

(104 citation statements)

References 185 publications

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“…Further, ventilatory problems occur frequently because an intact abdominal wall is required for adequate spontaneous ventilation [4]. Lastly, it is associated with local complications such as ventral hernia development due to fascial retraction and entero-atmospheric fistulas (EAF) [1][2][3][4].…”

Section: Discussionmentioning

confidence: 99%

“…Historically, patients with a septic abdomen who underwent a planned re-laparotomy because of alleged gross contamination used to be another indication of open abdominal treatment [1][2][3][4][5][6]. However, a randomized clinical trial comparing on-demand with planned re-laparotomy strategy in patients with severe peritonitis did not reveal any differences on death or major peritonitis-related morbidity between both groups [7].…”

Section: Introductionmentioning

confidence: 99%

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Underlying disease determines the risk of an open abdomen treatment, final closure, however, is determined by the surgical abdominal history

Karhof

Haverkort

Simmermacher

et al. 2019

Eur J Trauma Emerg Surg

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Introduction Temporary abdominal closure is frequently used in several situations such as abbreviated surgery in damage control situations or when closing is impossible due to organ distention or increased abdominal pressure. The ultimate goal is to eventually close the fascia; however, little is known about factors predicting abdominal closure. The purpose of this study was to identify characteristics associated with the need for open abdomen as well as indicating the possibility of delayed fascial closure after a period of open abdominal treatment. Methods A retrospective review of all patients that underwent midline laparotomy between January 2008 and December 2012 was performed. Both factors predicting open abdominal treatment and possibility to close the fascia afterwards were identified and analyzed by univariate and multivariate analyses. Results 775 laparotomies in 525 patients (60% male) were included. 109 patients (21%) had an open abdomen with a mortality rate of 27%. Male gender and acidosis were associated with open abdominal treatment. In 54%, the open abdomen could be closed by delayed fascial closure. The number of laparotomies both before and during temporary abdominal treatment was associated with failure of closure. Conclusion In this study, male sex and physiological derangement, reflected by acidosis, were independent predictors of open abdominal treatment. Furthermore, the success of delayed fascial closure depends on number of abdominal surgical procedures.Moreover, based on our experiences, we suggest to change modalities early on, to prevent multiple fruitless attempts to close the abdomen.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Underlying disease determines the risk of an open abdomen treatment, final closure, however, is determined by the surgical abdominal history

Karhof

Haverkort

Simmermacher

et al. 2019

Eur J Trauma Emerg Surg

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“…For patients suspected of having NOMI on the basis of abdominal physical findings, computed tomography (CT) findings, or laboratory findings, we aggressively performed laparotomy to obtain a definite diagnosis. The primary surgery consisted of resection of the ischemic intestinal tract without anastomosis and open abdominal management to shorten the operation time that allows a systematic search for the progression of intestinal necrosis . We carefully treated and observed the patients for 24–48 h in the intensive care unit so as not to miss the progression of necrosis or ischemia of the intestinal tract.…”

Section: Methodsmentioning

confidence: 99%

A strategy for improving the prognosis of non‐occlusive mesenteric ischemia (NOMI): a single‐center observational study

Nakamura

Yui

Muratsu

et al. 2019

Acute Medicine & Surgery

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Aim The purpose of this study was to determine the prognostic factors of non‐occlusive mesenteric ischemia (NOMI) and to examine treatment strategies that could improve its prognosis. Methods We retrospectively identified 30 patients who underwent emergency laparotomy for NOMI in Kansai Medical University Hospital (Hirakata, Japan) from April 2013 to December 2017. We examined prognostic factors related to discharge outcome and also examined the prognostic impact of open abdominal management and second look operation strategy (OSS) by dividing the patients into the non‐OSS group and the OSS group. Results The primary end‐point was a prognostic factor for outcome at discharge of the 30 patients. The outcome at discharge was compared between the survival group and the death group. Multivariate analysis was undertaken on two items from the univariate analysis that showed a significant difference (computed tomography findings of intestinal pneumatosis and acute disseminated intravascular coagulation [DIC] score). As a result, there was a significant difference in the factors of intestinal pneumatosis (odds ratio = 0.054; 95% confidence interval, 0.005–0.607; P = 0.018) and DIC score (odds ratio = 1.892; 95% confidence interval, 1.077–3.323; P = 0.027). The secondary end‐point was the treatment outcome before and after the application of OSS. Operation time was significantly shorter and the amount of bleeding was also significantly less in the OSS group. Conclusion Computed tomography findings of intestinal pneumatosis and the acute disseminated intravascular coagulation score were found to be prognostic factors for survival in patients with NOMI. Aggressive laparotomy to determine the definitive diagnosis is needed and OSS could be useful to improve patient prognosis for survival from NOMI.

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“…Coccolini et al [10] systematically reviewed all the present literature on the role of open abdomen in non-trauma patient. 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 evidencedirected utilization of OA management in non-trauma emergency surgery and critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

Role of laparostomy in preventing early morbidity and mortality in advanced peritonitis patients

2020

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Background: Very few studies are available for the indication and the need of laparostomy in cases of faecal, biliary peritonitis and gangrenous bowel. The open abdomen procedure is one of the greatest surgical advances in recent times, avoiding the development of abdominal compartment syndrome. Methods: The present study was a prospective study of the patients who underwent laparostomy during 2yrs study period. Patients who met the inclusion criteria were included in the study. The indications, complications and outcomes of the study were noted. Results: Majority of the patients are in the age group of 31 to 40yrs. With laparostomy and damage control surgery recovery was seen in 86.6% patients. Post-operative complications were seen in 33.3% of the patients, with electrolyte imbalance, enterocutaneous fistula, anastomotic leak being the most common complications. Deaths were secondary to septicaemia with mortality rate 16.6%. Conclusion: Laparostomy or open abdomen is a useful emergency measure in certain conditions where there is a need for re-exploration for abdomen and cannot be closed due to gross edema and contamination. It reduces operative time and also facilitates re-look operations.

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

Cited by 94 publications

References 185 publications

Underlying disease determines the risk of an open abdomen treatment, final closure, however, is determined by the surgical abdominal history

Underlying disease determines the risk of an open abdomen treatment, final closure, however, is determined by the surgical abdominal history

A strategy for improving the prognosis of non‐occlusive mesenteric ischemia (NOMI): a single‐center observational study

Role of laparostomy in preventing early morbidity and mortality in advanced peritonitis patients

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