Open Abdomen: The Surgeons’ Challenge

Abstract

An open abdomen is defined as purposely foregoing fascial closure of the abdomen after the cavity is opened. Management of complex abdominal problems with the open abdomen and temporary abdominal closure techniques has become a common and valuable tool in surgery. Several challenging clinical situations can necessitate leaving the abdominal cavity open after surgery, resulting in an open abdomen. The indications for open abdomen are as follows: Damage control for life-threatening intraabdominal bleeding, severe acute pancreatitis, severe abdominal sepsis, and prevention and treatment of the abdominal compartment syndrome. Damage control surgery is based on a rapid control of bleeding and focuses on reversing physiologic exhaustion in a critically ill or injured patient. In severe abdominal sepsis, the intervention should be abbreviated due to suboptimal local conditions for healing and global susceptibility to spiraling organ failure. Abdominal compartment syndrome (ACS) is commonly encountered and the only solution is decreasing the pressure by decompressive laparotomy. Open abdomen is associated with significant complications, including wound infection, fluid and protein loss, a catabolic state, loss of abdominal wall domain, and development of enteroatmospheric fistula; however, if the indications are clear, it can become a most valuable resource in treating these conditions.