Open Abdomen: Indications, Surgical Management, and Critical Care

Abstract

Open abdomen (OA) is a condition in which at the end of laparotomy, performed whether for trauma or for non-trauma surgical emergencies, the fascial edges are left purposefully open, in order to avoid the increase of intra-abdominal pressure (IAP) and the onset of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS), to allow abdominal planned re-exploration(s) (PR), or to manage intra-abdominal infections, in a stepwise approach. This strategy induces dramatic changes in patient’s physiology and may render the patient prone to the onset of complications, such as development of the entero-atmospheric fistula. Due to the complexity of this peculiar clinical setting, doctors who treat OA patients must be aware about the correct indications at the indicative laparotomy, technical elements for temporary abdominal closure (TAC), strategies for fistula takedown, and definitive reconstruction of the abdominal wall, in addition to the elements of critical care. This chapter, written by authors with a wide experience in the management of OA patients, is an updated and concise but comprehensive overview encompassing all the technical aspects of the problem, and it may represent a useful tool for all surgeons, intensivists, and nurses who take care of patients with an open abdomen.