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Open Abdomen Management

Open Abdomen

A technique, also known as laparostomy, in which the fascia is left open intentionally to avoid elevation of intra-abdominal pressure (IAP) and where surgical re-exploration is desirable. Temporary abdominal closure (TAC) is achieved using a dressing or technology intended to protect the exposed viscera.

About Open Abdomen

In the management of various surgical conditions including perionitis, intra-abdominal trauma and mesenteric ischaemia, early definitive closure of the abdominal wall (i.e. closure of the fascial layer and skin) may place the patient at risk of developing intra-abdominal hypertension (IAH) and/or abdominal compartment syndrome (ACS). In these cases, patients are increasingly managed using a damage control approach with abbreviated operating times and a laparostomy to allow subsequent re-exploration or to prevent elevated intra-abdominal pressure2.

The principal goal is to manage the critically ill patient at risk of developing systemic complications by controlling both the abdominal contents and the opening that gives access to the abdominal cavity. The control of intra-abdominal fluid secretion and preservation of the fascia is a major challenge in the management of these patients1. The ultimate goal is to achieve delayed primary fascial closure. On occasion, when the latter is not possible, functional abdominal closure using mesh or other prosthetic materials is reasonable and helps to minimise subsequent herniation.

1 Schachtrupp A, Fackeldey V, Klinge U, et al. Temporary closure of the abdominal wall (laparostomy). Hernia 2002; 6(4): 155-62.

2 Kaplan M. Managing the open abdomen. Ostomy Wound Manage 2004; 50(1A Suppl): C2, 1-8.

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