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The Catastrophic Abdominal Wall—Management and Reconstruction

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Coloproctology

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Abstract

An infected abdominal wall defect with fistulation and/or an infected synthetic mesh presents significant challenges in management. Morbidity both physical and psychological is high. The principles of management are to eliminate sepsis and to optimise the patient and map anatomy for what is likely to be a technically demanding reconstruction, which may require a staged approach. A standardised approach through the use of multi-disciplinary teams is advantageous and dual surgeons with experience in GI surgery and abdominal wall reconstruction operating together advocated.

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References

  1. Balogh Z, Jones F, D’Amours S, Parr M, Sugrue M. Continuous intra-abdominal pressure management technique. Am J Surg. 2004;188(6):679–84.

    Article  PubMed  Google Scholar 

  2. Cheatham ML, White MW, Sagraves SG, Johnson JL, Block EF. Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J Trauma. 2000;49:621–6.

    Article  CAS  PubMed  Google Scholar 

  3. Carlson GL, Patrick H, Amin AI, Gladys McPherson G, MacLennan G, Mowatt G, Campbell B. Management of the open abdomen; a national study of clinical outcome and safety of negative pressure wound therapy. Ann Surg. 2013;257(6):1154–9.

    Article  PubMed  Google Scholar 

  4. Robledo FA, Luque-de-León E, Suárez R, Sánchez P, de-la-Fuente M, Vargas A, Mier J. Open versus closed management of the abdomen in the surgical treatment of severe secondary peritonitis: a randomized clinical trial. Surg Infect. 2007;8(1):63–72.

    Article  Google Scholar 

  5. Becker HP, Willms A, Schwab R. Small bowel fistula and the open abdomen. Scand J Surg. 2007;96:263–71.

    Article  CAS  PubMed  Google Scholar 

  6. Fernandez L, Norwood S, Roettger R, Wilkins III HE. Temporary intravenous bag silo closure in severe abdominal trauma. J Trauma. 1996;40:258–60.

    Article  CAS  PubMed  Google Scholar 

  7. Fansler RF, Taheri P, Cullinane C, Sabates B, Flint LM. Polypropylene mesh closure of the complicated abdominal wound. Am J Surg. 1995;170(1):15–8.

    Article  CAS  PubMed  Google Scholar 

  8. Greene MA, Mullins RJ, Malangoni MA, Feliciano PD, Richardson JD, Polk Jr HC. Laparotomy wound closure with absorbable polyglycolic acid mesh. Surg Gynecol Obstet. 1993;176(3):213–8.

    CAS  PubMed  Google Scholar 

  9. Barker DE, Kaufman HJ, Smith LA, Ciraulo DL, Richart CL, Burns RP. Vacuum pack technique of temporary abdominal closure: a 7-year experience with 112 patients. J Trauma. 2000;48(2):201–7.

    Article  CAS  PubMed  Google Scholar 

  10. Bee TK, Croce MA, Magnotti LJ, Zarzaur BL, Maish III GO, Minard G, Schroeppel TJ, Fabian TC. Temporary abdominal closure techniques: a prospective randomized controlled trial comparing polyglactin 910 mesh and vacuum-assisted closure. J Trauma. 2008;65:337–44.

    Article  PubMed  Google Scholar 

  11. Demetriades D. Total management of the open abdomen. Int Wound J. 2012;9(Suppl 1):17–24.

    Article  PubMed  Google Scholar 

  12. Suliburk JW, Ware DN, Balogh Z, McKinley BA, Cocanour CS, Kozar RA, Moore FA, Ivatury RR. Vacuum-assisted wound closure achieves early fascial closure of open abdomens after severe trauma. J Trauma. 2003;55(6):1155–61.

    Article  PubMed  Google Scholar 

  13. Miller PR, Thompson JT, Faler B, Meredith JW, Chang MC. Late fascial closure in lieu of ventral hernia: the next step in open abdomen management. J Trauma. 2002;53(5):843–9.

    Article  PubMed  Google Scholar 

  14. Bosscha K, Hulstaert PF, Visser MR, van Vroonhoven TJ, van der Werken C. Open management of the abdomen and planned reoperations in severe bacterial peritonitis. Eur J Surg. 2000;166(1):44–9.

    Article  CAS  PubMed  Google Scholar 

  15. Connolly PT, Teubner A, Lees NP, Anderson ID, Scott NA, Carlson GL. Outcome of reconstructive surgery for intestinal fistula in the open abdomen. Ann Surg. 2008;247(3):440–4.

    Article  PubMed  Google Scholar 

  16. Adkins AL, Robbins J, Villalba M, Bendick P, Shanley CJ. Open abdomen management of intra-abdominal sepsis. Am Surg. 2004;70(2):137–40.

    PubMed  Google Scholar 

  17. Dutton WD, Diaz Jr JJ, Miller RS. Critical care issues in managing complex open abdominal wound. J Intensive Care Med. 2012;27(3):161–71.

    Article  PubMed  Google Scholar 

  18. Cheatham ML, Safcsak K, Brzezinski SJ, Lube MW. Nitrogen balance, protein loss, and the open abdomen. Crit Care Med. 2007;35(1):127–31.

    Article  CAS  PubMed  Google Scholar 

  19. The surgical management of patients with acute intestinal failure. Association of Surgeons of Great Britain and Ireland. Issues in Professional Practice London 2010.

    Google Scholar 

  20. Campos A, Andrade D, Campos G, Matias J, Coelho J. A multivariate model to determine prognostic factors in gastrointestinal fistulas. J Am Coll Surg. 1999;188(5):483–90.

    Article  CAS  PubMed  Google Scholar 

  21. Williams NM, Scott NA, Irving MH. Successful management of external duodenal fistula in a specialized unit. Am J Surg. 1997;173(3):240–1.

    Article  CAS  PubMed  Google Scholar 

  22. Martinez J, Luque-de-Leon E, Mier J, Blanco-Benavides R, Robledo F. Systematic management of postoperative enterocutaneous fistulas: factors related to outcomes. World J Surg. 2008;32(3):436–43.

    Article  PubMed  Google Scholar 

  23. Streat S, Beddoe A, Hill G. Aggressive nutritional support does not prevent protein loss despite fat gain in septic intensive care patients. J Trauma. 1987;27(3):262–6.

    Article  CAS  PubMed  Google Scholar 

  24. Carlson GL, Dark P. Acute intestinal failure. Curr Opin Crit Care. 2010;16(4):347–52.

    Article  PubMed  Google Scholar 

  25. Carlson GL, Gardinger K, McKee R, MacFie J, Vaizey CJ. The surgical management of patients with acute intestinal failure. London: Association of Surgeons of Great Britain and Ireland; 2010. p. 40.

    Google Scholar 

  26. Visschers R, Olde Damink S, Winkens B, Soeters P, van Gemert W. Treatment strategies in 135 consecutive patients with enterocutaneous fistulas. World J Surg. 2008;32(3):445–53.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Semin Dial. 2004;17:432–7.

    Article  PubMed  Google Scholar 

  28. Teubner A, Morrison K, Ravishankar HR, Anderson ID, Scott NA, Carlson GL. Fistuloclysis can successfully replace parenteral feeding in the nutritional support of patients with enterocutaneous fistula. Br J Surg. 2004;91(5):625–31.

    Article  CAS  PubMed  Google Scholar 

  29. Schecter WP, Hirshberg A, Chang DS, Harris HW, Napolitano LM, Wexner SD, et al. Enteric fistulas: principles of management. J Am Coll Surg. 2009;209(4):484–91.

    Article  PubMed  Google Scholar 

  30. Jernigan TW, Fabian TC, Croce MA, Moore N, Pritchard FE, Minard G, et al. Staged management of giant abdominal wall defects. Trans Meet Am Surg Assoc. 2003;121:43–51.

    Google Scholar 

  31. Agwunobi AO, Carlson GL, Anderson ID, Irving MH, Scott NA. Mechanisms of intestinal failure in Crohn’s disease. Dis Colon rectum. 2001;44(12):1834–7.

    Article  CAS  PubMed  Google Scholar 

  32. ten Broek RPG, Issa Y, van Santbrink EJP, Bouvy ND, Kruitwagen RFPM, Jeekel J, Bakkum EA, Rovers MM, van Goor H. Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. BMJ. 2013;347:f5588.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Slade DA, Carlson GL. Takedown of enterocutaneous fistula and complex abdominal wall reconstruction. Surg Clin North Am. 2013;93(5):1163–83.

    Article  PubMed  Google Scholar 

  34. A-Malik R, Scott NA. Double near and far prolene suture closure: a technique for abdominal wall closure after laparostomy. Br J Surg. 2001;88(1):146–7.

    Article  CAS  PubMed  Google Scholar 

  35. Farooque F, Jacombs AS, Roussos E, Read JW, Dardano AN, Edye M, Ibrahim N. Preoperative abdominal muscle elongation with botulinum toxin A for complex incisional ventral hernia repair. ANZ J Surg. 2016;86(1–2):79–83.

    Article  PubMed  Google Scholar 

  36. Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg. 1990;86(3):519–26.

    Article  CAS  PubMed  Google Scholar 

  37. Itani KMF, Rosen M, Vargo D, Awad SS, Denoto G, Butler CE, et al. Prospective study of single-stage repair of contaminated hernias using a biologic porcine tissue matrix: the RICH study. Surgery. 2012;152(3):498–505.

    Article  PubMed  Google Scholar 

  38. Blatnik J, Jin J, Rosen M. Abdominal hernia repair with bridging acellular dermal matrix—an expensive hernia sac. Am J Surg. 2008;196(1):47–50.

    Article  PubMed  Google Scholar 

  39. Lambe G, Russell C, West C, Kalaiselvan R, Slade DAJ, Anderson ID, et al. Autologous reconstruction of massive enteroatmospheric fistulation with a pedicled subtotal lateral thigh flap. Br J Surg. 2012;99(7):964–72.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of General and Colorectal Surgery, Spire Medical Hospital, Manchester, UK

    Iain David Anderson MD, FRCS, BSc & Jonathan Epstein MBChB, MD, FRCS

Authors
  1. Iain David Anderson MD, FRCS, BSc
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  2. Jonathan Epstein MBChB, MD, FRCS
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Corresponding author

Correspondence to Iain David Anderson MD, FRCS, BSc .

Editor information

Editors and Affiliations

  1. Colorectal Surgery, Singleton Hospital, Swansea, United Kingdom

    John Beynon

  2. Department of Colorectal Surgery, Singleton Hospital, Swansea, United Kingdom

    Dean Anthony Harris

  3. Department of Colorectal Surgery, Singleton Hospital, Swansea, United Kingdom

    Mark Davies

  4. Department of Colorectal Surgery, Singleton Hospital, Swansea, United Kingdom

    Martyn Evans

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Anderson, I.D., Epstein, J. (2017). The Catastrophic Abdominal Wall—Management and Reconstruction. In: Beynon, J., Harris, D., Davies, M., Evans, M. (eds) Coloproctology. Springer, Cham. https://doi.org/10.1007/978-3-319-55957-5_2

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  • DOI: https://doi.org/10.1007/978-3-319-55957-5_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-55955-1

  • Online ISBN: 978-3-319-55957-5

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