Skip to main content

Mistakes in the Open Abdomen

  • Chapter
  • First Online:
Open Abdomen

Part of the book series: Hot Topics in Acute Care Surgery and Trauma ((HTACST))

  • 1071 Accesses

Abstract

Throughout the clinical spectrum of emergency and trauma surgery, the referral, the consultation, the key moments of early preoperative care, and the surgery, remember the patient’s life is in your hands. Not only is the family hoping for the best outcome, but the clinical team is wishing the patient through their critical illness. The patient’s survival is dependent on the right call—no mistakes and excellent decision-making—everything is your responsibility! Your decision process and surgical technique combined will hopefully provide excellent care and avoid significant mistakes.

With mortality over 10% for most emergency laparotomies, a decision to leave the abdomen open indicates the patient is at a level of even higher risk. Make an error in care, and your patient’s mortality will climb.

This chapter explores the mistakes you could make and suggests ways to avoid them throughout the spectrum of care from preoperative to closure.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. Cheatham M, Safcsak K. Is the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival? Crit Care Med. 2010;38:402–7.

    Article  PubMed  Google Scholar 

  2. National Emergency Lapaorotmy Network (UK); http://www.nela.org.uk.

  3. Huddart S, et al. Use of a pathway quality improvement care bundle to reduce mortality after emergency laparotomy. Br J Surg. 2015;102(1):57–66.

    Article  CAS  PubMed  Google Scholar 

  4. Khan A, Hsee L, Mathur S, et al. Damage-control laparotomy in nontrauma patients: review of indications and outcomes. J Trauma Acute Care Surg. 2013;75(3):365–8.

    Article  PubMed  Google Scholar 

  5. Fietsam R, Villalba M, Glover J, et al. Intra-abdominal compartment syndrome as a complication of ruptured abdominal aortic aneurysm repair. Am Surg. 1989;55:396–402.

    PubMed  Google Scholar 

  6. Bruns B, Ahmad S, O’Meara L, et al. Nontrauma open abdomens: a prospective observational study. J Trauma Acute Care Surg. 2016;80(4):631–736.

    Article  PubMed  Google Scholar 

  7. Mason SA, Nathens AB, Finnerty CC. Hold the pendulum: rates of acute kidney injury are increased in patients who receive resuscitation volumes less than predicted by the Parkland equation. Ann Surg. 2016;264(6):1142–7.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Balogh Z, Caldwell E, Heetveld M, D’Amours S, Schlaphoff G, Harris I, Sugrue M. Institutional practice guidelines on management of pelvic fracture-related hemodynamic instability: do they make a difference? J Trauma. 2005;58:778–82.

    Article  PubMed  Google Scholar 

  9. Sugrue M, Dohan R et al. World Union of Wound Healing Societies (WUWHS) Consensus Document. Closed surgical incision management: understanding the role of NPWT. Wounds International. 2016.

    Google Scholar 

  10. Harvin JA, Mims MM, Duchesne JC, Cox CS, et al. Chasing 100%: the use of hypertonic saline to improve early, primary fascial closure after damage control laparotomy. J Trauma Acute Care Surg. 2013;74:426–32.

    Article  PubMed  Google Scholar 

  11. www.wsacs.org accessed 21 October 2016.

  12. Sugrue M, Bauman A, Jones F, et al. Clinical examination is an inaccurate predictor of intraabdominal pressure. World J Surg. 2002;26:1428–31.

    Article  PubMed  Google Scholar 

  13. Ivatury R, Porter J, Simon R, et al. Intra-abdominal hypertension after life-threatening penetrating abdominal trauma: prophylaxis, incidence, and clinical relevance to gastric mucosal pH and abdominal compartment syndrome. J Trauma Acute Care Surg. 1998;44:1016–21.

    Article  CAS  Google Scholar 

  14. Smit M, Buddingh K, Bosma B, et al. Abdominal compartment syndrome and intra-abdominal ischaemia in patients with severe acute pancreatitis. World J Surg. 2016;40:1454–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Mentula P, Hienonen P, Kemppainen E, Puolakkainen P, Leppäniemi A. Surgical decompression for abdominal compartment syndrome in severe acute pancreatitis. Arch Surg. 2010;145(8):764–9.

    Article  PubMed  Google Scholar 

  16. Cheatham M, Demetriades D, Fabian T, et al. Prospective study examining clinical outcomes associated with a negative pressure wound therapy system and Barker’s vacuum packing technique. World J Surg. 2013;37:2018–30.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Petersson U, Acosta S, Bjorck M. Vacuum-assisted wound closure and mesh-mediated fascial traction-a novel technique for late closure of the open abdomen. World J Surg. 2007;31:2133–7.

    Article  PubMed  Google Scholar 

  18. Miller P, Meredith J, Johnson J, et al. Prospective evaluation of vacuum-assisted fascial closure after open abdomen: planned ventral hernia rate is substantially reduced. Ann Surg. 2004;239:608–14.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Atema J, Gans S, Boermeester M. Systematic review and meta-analysis of the open abdomen and temporary abdominal closure techniques in non-trauma patients. World J Surg. 2015;39(4):912–25.

    Article  CAS  PubMed  Google Scholar 

  20. Cothren CC, Moore EE, Johnson JL. One hundred percent fascial approximation with sequential abdominal closure of the open abdomen. Am J Surg. 2006;192:238–42.

    Article  PubMed  Google Scholar 

  21. Lambertz A, Mihatsch C, Roth A, et al. Fascial closure after open abdomen: initial indication and early revisions are decisive factors- a retrospective cohort study. Int J Surg. 2015;13:12–6.

    Article  CAS  PubMed  Google Scholar 

  22. Smith JW, Neal Garrison R, Matheson PJ, Harbrecht BG, Benns MV, Franklin GA, Miller KR, Bozeman MC, Richardson DJ. Adjunctive treatment of abdominal catastrophes and sepsis with direct peritoneal resuscitation: indications for use in acute care surgery. J Trauma Acute Care Surg. 2014;7:393–9.

    Article  Google Scholar 

  23. Sugrue M, Maier R, editors. Emergency surgery performance, quality and outcome consensus summit-resource for optimal care of emergency surgery. Donegal; 2016. isbn:978-0-9926109-9-9.

    Google Scholar 

  24. www.dcra.ie accessed 21 October 2016.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michael Sugrue .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sugrue, M., Connolly, M. (2018). Mistakes in the Open Abdomen. In: Coccolini, F., Ivatury, R., Sugrue, M., Ansaloni, L. (eds) Open Abdomen. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-319-48072-5_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-48072-5_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-48071-8

  • Online ISBN: 978-3-319-48072-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics