Slovenská chirurgia 4/2022

Open abdomen: current recommendations and literature review

The open abdomen treatment technique has gained a place in the era of modern surgery in clearly indicated cases. Based on the recommendations of the World Association for Emergency Surgery (WSES), OA is used in the treatment of critically ill trauma and nontraumatic patients with abdominal involvement who are at high risk of developing intraabdominal hypertension (IAH) and compartment syndrome (ACS), in patients with the impossibility of adequate control abdominal infection with the development of septic complications, as part of the damage control surgery protocol (DCS), but also when the primary laparotomy closure is impossible for visceral edema or for the purpose of repeated future reexplorations of the abdominal cavity. The OA classification was revised in 2016 and includes four basic grades. Although the OA methodology has undergone various modifications over the years, the essence remains the pursuit of primary fascial closure in the shortest possible time. This basic goal can only be achieved through a detailed cooperation of surgical and intensivist management. From an intensivist point of view, early enteral nutrition of patients with OA has an important position, which has significant advantages compared to total parenteral nutrition. Over the years, several different techniques for temporary abdominal closure (TAC) have been described. Today, following the guidelines and recommendations of specialized groups and the results of studies, it is recommended to use the NPWT vacuum therapy with a dynamic suture of the fascial layer as method of choice. The ideal TAC should protect the visceroabdominal contents, prevent its evisceration, drain the peritoneal/septic exudate, act prophylactically against the formation of enteroatmospheric fistulas (EAF) and facilitate the planned relaparotomy/ies. NPWT with continuous fascial traction fulfills all criteria and appears to be currently the most optimal therapy for open abdomen.

Keywords: open abdomen, temporary closure of the abdominal wall, compartment syndrome, negative pressure therapy