Management of the Open Abdomen - The Eastern Association for the Surgery of Trauma

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Eastern Association for the Surgery of Trauma

Management of the Open Abdomen

Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy: results from the prospective AAST Open Abdomen registry.

Bradley MJ, Dubose JJ, Scalea TM, Holcomb JB, Shrestha B, Okoye O, Inaba K, Bee TK, Fabian TC, Whelan JF, Ivatury RR; AAST Open Abdomen Study Group.

JAMA Surg. 2013 Oct;148(10):947-54.

Rationale for inclusion: To identify independent risk factors of enterocutaneous fistula, enteroatmospheric fistula, and intraabdominal sepsis following damage control laparotomy, utilization of the AAST registry found that large bowel resection, large volume fluid resuscitation, and number of abdominal re-explorations were independently associated with the development of these complications.

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Chasing 100%: the use of hypertonic saline to improve early, primary fascial closure after damage control laparotomy.

Harvin JA, Mims MM, Duchesne JC, Cox CS Jr, Wade CE, Holcomb JB, Cotton BA.

J Trauma Acute Care Surg. 2013 Feb;74(2):426-30; discussion 431-2.

Rationale for inclusion: This study advocates for the use of 3% hypertonic saline as maintenance fluid (30mL/hr) after damage control laparotomy, citing a 100% primary fascial closure rate as compared to a 76% fascial closure rate in patients who received isotonic fluids at 125mL/hr.

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Open abdominal management after damage-control laparotomy for trauma: a prospective observational American Association for the Surgery of Trauma multicenter study.

Dubose JJ, Scalea TM, Holcomb JB, Shrestha B, Okoye O, Inaba K, Bee TK, Fabian TC, Whelan J, Ivatury RR; AAST Open Abdomen Study Group.

J Trauma Acute Care Surg. 2013 Jan;74(1):113-20; discussion 1120-2.

Rationale for inclusion: The results of this AAST multi-center observational trial identified risk factors for failure to achieve primary closure following damage control laparotomies. This study found the number of re-explorations required, development of intraabdominal abscess, bloodstream infection, acute renal failure, enteric fistula, and ISS greater than 15 were all associated with failure to achieve primary fascial closure.

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Temporary abdominal closure techniques: a prospective randomized trial comparing polyglactin 910 mesh and vacuum-assisted closure.

Bee TK, Croce MA, Magnotti LJ, Zarzaur BL, Maish GO, Minard G, Schroeppel TJ, Fabian TC.

J Trauma. 2008 Aug;65(2):337-42; discussion 342-4.

Rationale for inclusion: This represents a single institution, randomized prospective study comparing polyglactin mesh versus vacuum assisted closure for use in abdominal closure following damage control laparotomies with no differences in primary closure rates or fistula complications between the two groups.

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Experience with vacuum-pack temporary abdominal wound closure in 258 trauma and general and vascular surgical patients.

Barker DE, Green JM, Maxwell RA, Smith PW, Mejia VA, Dart BW, Cofer JB, Roe SM, Burns RP.

J Am Coll Surg. 2007 May;204(5):784-92; discussion 792-3.

Rationale for inclusion: A comparative analysis between two patient populations utilizing the vacuum-pack, this descriptive study found similar rates of fascial closure and complications between trauma patients and general surgical and vascular patients requiring damage control surgery with subsequent temporary open abdominal wounds.

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One hundred percent fascial approximation with sequential abdominal closure of the open abdomen.

Cothren CC, Moore EE, Johnson JL, Moore JB, Burch JM.

Am J Surg. 2006 Aug;192(2):238-42.

Rationale for inclusion: This small case series achieved 100% primary fascial closure with the incorporation of fascial tension across the open abdomen in addition to vacuum-assisted closure techniques.

Watch the EAST Minute Video - https://youtu.be/FS1e9MA-q1o

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Complications after 344 damage-control open celiotomies.

Miller RS, Morris JA Jr, Diaz JJ Jr, Herring MB, May AK.

J Trauma. 2005 Dec;59(6):1365-71; discussion 1371-4.

Rationale for inclusion: This case series of 344 damage control laparotomies documented a persistently high complication rate (25%) associated with the open abdomen, reinforcing the need for early fascial closure, identifying those patients who achieved fascial closure <8 days incurred the least morbidity.

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Prospective evaluation of vacuum-assisted fascial closure after open abdomen: planned ventral hernia rate is substantially reduced.

Miller PR, Meredith JW, Johnson JC, Chang MC.

Ann Surg. 2004 May;239(5):608-14; discussion 614-6.

Rationale for inclusion: This prospective analysis elaborated on the use of vacuum-assisted fascial closure for treatment of the open abdomen under a defined protocol, citing improved fascial closure rates (88%) and decreased morbidity.

Watch the EAST Minute Video - https://www.youtube.com/watch?v=FEosbetrqkg

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Vacuum pack technique of temporary abdominal closure: a 7-year experience with 112 patients.

Barker DE, Kaufman HJ, Smith LA, Ciraulo DL, Richart CL, Burns RP.

J Trauma. 2000 Feb;48(2):201-6; discussion 206-7.

Rationale for inclusion: This single institution early case series documents the use of the vacuum pack technique as a simple and safe method for management of the open abdomen, but cites high complication rates and only a 55.4% rate of primary fascial closure.

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Citations - To review the number of citations for this landmark paper, visit Google Scholar.