Slovenská chirurgia 2/2023

New techniques used in the management of Open Abdomen

Open Abdomen (OA) is a technique that is used in critically ill trauma and non-trauma patients in clearly indicated cases. In principle, this methodology is used for abdominal injury as part of the damage control surgery protocol (DCS), for patients with high risk of intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS), but also in a case of development of uncontrollable abdominal infection and septic complications. As in all medical fields, even in surgery, we encounter a constant increase in new knowledge, procedures and recommendations for patient management. In the last years, recent studies dealing with the technique of OA have been discussing the methodology of direct peritoneal resuscitation (DPR) and also the potential benefit of using transverse laparotomy compared to medial laparotomy. Clinical studies are demonstrating benefit of the additional use of DPR in abdominal trauma with the development of hemorrhagic shock in a protocol of DCS. DPR led to a decrease in tissue edema, a decrease in the incidence of abdominal complications, as well as a reduction in the time required for the definitive closure of the OA. That is why our current review article provides a detailed overview of recent studies dealing with the issue of OA from the point of view of the use of DPR. The article also provides an overview of the possibilities of using transverse laparotomy compared to the traditionally used midline laparotomy.

Keywords: open abdomen, direct peritoneal resuscitation, transverse laparotomy