Open Abdomen: Historical Notes

  • Rao R. IvaturyEmail author
Part of the Hot Topics in Acute Care Surgery and Trauma book series (HTACST)


The story of “open abdomen” management (OAM) is reminiscent of many other advances in medicine: described, forgotten, reinvented, ridiculed, and finally accepted. The science of OAM continues to unfold and presents us with a fascinating glimpse into the mysteries of pressure–perfusion phenomena, cytokine response to injury and sepsis, the splanchnic bed, and its role as the motor for multiorgan failure, just to name a few. It is a rational surgical approach, based on solid physiologic principles. Many of the details of OAM management will be discussed in detail in other pages of this work. This chapter will present the evolutionary history of OAM from its origin to the current state.


  1. 1.
    Ogilvie WH. The late complications of abdominal war wounds. Lancet. 1940;2:253–56. Quoted in: Kreis BE, Otterloo JCA, Kreis EW. Open abdomen management: A review of its history and a proposed management algorithm. Med Sci Monit. 2013;19:524–533.Google Scholar
  2. 2.
    Ogilvie WH. Surgical lessons of war applied to civil practice. Br Med J. 1945;1(4400):619–23. Quoted in: Kreis BE, Otterloo JCA, Kreis EW. Open abdomen management: a review of its history and a proposed management algorithm. Med Sci Monit. 2013;19:524–533.Google Scholar
  3. 3.
    Ertel W, Oberholzer A, Platz A, et al. Incidence and clinical pattern of the abdominal compartment syndrome after “damage-control” laparotomy in 311 patients with severe abdominal and/or pelvic trauma. Crit Care Med. 2000;28(6):1747.CrossRefPubMedGoogle Scholar
  4. 4.
    Steinberg D. On leaving the peritoneal cavity open in acute generalized suppurative peritonitis. Am J Surg. 1979;137(2):216–20.CrossRefPubMedGoogle Scholar
  5. 5.
    Duff JH, Moffat J. Abdominal sepsis managed by leaving abdomen open. Surgery. 1981;90(4):774–8.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Maetani S, Tobe T. Open peritoneal drainage as effective treatment of advanced peritonitis. Surgery. 1981;90:804–9.PubMedGoogle Scholar
  7. 7.
    Mughal MM, Bancewicz J, Irving MH. “Laparostomy”: a technique for the management of intractable intra-abdominal sepsis. Br J Surg. 1986;73(4):253–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Schein M, Saadia R, Decker GG. The open management of the septic abdomen. Surg Gynecol Obstet. 1986;163(6):587–92.PubMedGoogle Scholar
  9. 9.
    Schein M, Saadia R, Jamieson JR, Decker GA. The “sandwich technique” in the management of the open abdomen. Br J Surg. 1986;73(5):369–70.CrossRefPubMedGoogle Scholar
  10. 10.
    Schein M, Saadia R, Freinkel Z, Decker G. Aggressive treatment of severe diffuse peritonitis: a prospective study. Br J Surg. 1988;75(2):173–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Garcia-Sabrido JL, Tallado JM, Christou NV, et al. Treatment of severe intra-abdominal sepsis and/or necrotic foci by an “open-abdomen” approach. Zipper and zipper-mesh techniques. Arch Surg. 1988;123(2):152–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Howard CA, Turner WW. Successful treatment of early, postoperative, necrotizing infection of the abdominal wall. Crit Care Med. 1989;17(6):586–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Hedderich GS, Wexler MJ, McLean AP, Meakins JL. The septic abdomen: open management with Marlex mesh with a zipper. Surgery. 1986;99(4):399–408.PubMedGoogle Scholar
  14. 14.
    Mastboom WJ, Kuypers HH, Schoots FJ, Wobbes T. Small-bowel perforation complicating the open treatment of generalized peritonitis. Arch Surg. 1989;124(6):689–92.CrossRefPubMedGoogle Scholar
  15. 15.
    Ivatury RR, Nallathambi M, Rao PM, et al. Open management of the septic abdomen: therapeutic and prognostic considerations based on APACHE II. Crit Care Med. 1989;17(6):511–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Ivatury RR, Nallathambi M, Rohman M, et al. Open management of the posttraumatic septic abdomen. Am Surg. 1990;56(9):548–52.PubMedGoogle Scholar
  17. 17.
    Wittmann DH, Aprahamian C, Bergstein JM. Etappenlavage: advanced diffuse peritonitis managed by planned multiple laparotomies utilizing zippers, slide fastener, and Velcro analogue for temporary abdominal closure. World J Surg. 1990;14(2):218–26.CrossRefPubMedGoogle Scholar
  18. 18.
    Christou NV, Barie PS, Dellinger EP, et al. Surgical Infection Society intra-abdominal infection study. Prospective evaluation of management techniques and outcome. Arch Surg. 1993;128(2):193–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Robledo FA, Luque-de-león E, Suárez R, et al. Open versus closed management of the abdomen in the surgical treatment of severe secondary peritonitis: a randomized clinical trial. Surg Infect. 2007;8(1):63–71.CrossRefGoogle Scholar
  20. 20.
    van Ruler O, Lamme B, Gouma DJ, et al. Variables associated with positive findings at relaparotomy in patients with secondary peritonitis. Crit Care Med. 2007;35(2):468–76.CrossRefPubMedGoogle Scholar
  21. 21.
    Rotondo MF, Schwab CW, McGonigal MD, et al. “Damage control”: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993;35(3):375–82.CrossRefPubMedGoogle Scholar
  22. 22.
    Roberts DJ, Ball CG, Feliciano DV, et al. History of the innovation of damage control for Management of Trauma Patients. Ann Surg. 2015;262(1):38–46. 1902-2016CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Ivatury RR, Simon RJ, Islam S, et al. A prospective randomized study of end points of resuscitation after major trauma: global oxygen transport indices versus organ-specific gastric mucosal pH. J Am Coll Surg. 1996;183(2):145–54.PubMedGoogle Scholar
  24. 24.
    McKinley BA, Kozar RA, Cocanour CS, Valdivia A, Sailors RM, Ware DN, Moore FA. Normal versus supranormal oxygen delivery goals in shock resuscitation: the response is the same. J Trauma. 2002;53(5):825–32.CrossRefPubMedGoogle Scholar
  25. 25.
    Richardson JD, Trinkle JK. Hemodynamic and respiratory alterations with increased intra-abdominal pressure. J Surg Res. 1976;20(5):401.CrossRefPubMedGoogle Scholar
  26. 26.
    Burch JM, Ortiz VB, Richardson JR, et al. Abbreviated laparotomy and planned reoperation for critically injured patients. Ann Surg. 1992;215:476–84.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Morris JA Jr, Eddy VA, Blinman TA, et al. The staged celiotomy for trauma. Issues in unpacking and reconstruction. Ann Surg. 1993;217(5):576–84.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Meldrum DR, Moore FA, Moore EE, et al. Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg. 1997;174(6):667–72.CrossRefPubMedGoogle Scholar
  29. 29.
    Ivatury RR, Diebel L, Porter JM, et al. Intra-abdominal hypertension and the abdominal compartment syndrome. Surg Clin North Am. 1997;77(4):783–800.CrossRefPubMedGoogle Scholar
  30. 30.
    Mayberry JC, Mullins RJ, Crass RA, et al. Prevention of abdominal compartment syndrome by absorbable mesh prosthesis closure. Arch Surg. 1997;132(9):957–62.CrossRefPubMedGoogle Scholar
  31. 31.
    Ivatury RR, Porter JM, Simon RJ, 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. 1998;44(6):1016.CrossRefPubMedGoogle Scholar
  32. 32.
    Sugrue M, Jones F, Jahangir Jannua K. Temporary abdominal closure: a prospective evaluation of its effects on renal and respiratory physiology. J Trauma. 1998;45(5):914–21.CrossRefPubMedGoogle Scholar
  33. 33.
    Schwab CW. Master surgeon lecture: damage control: 20 years of experience. Accessed 8 Dec 2016.
  34. 34.
    Schwab CW. Violence: America’s uncivil war–presidential address, Sixth Scientific Assembly of the Eastern Association for the Surgery of Trauma. J Trauma. 1993;35(5):657–65.CrossRefPubMedGoogle Scholar
  35. 35.
    Ivatury R, Cheatham M, Malbrain M, Sugrue M, editors. Abdominal compartment syndrome. Texas: Landes Boscience; 2006.Google Scholar
  36. 36.
    Cheatham ML, Malbrain ML, Kirkpatrick A, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. II. Recommendations. Intensive Care Med. 2007;33(6):951–62.CrossRefPubMedGoogle Scholar
  37. 37.
    Kirkpatrick AW, Roberts DJ, De Waele J, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39(7):1190–206.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Kirkpatrick AW, De Waele JJ, De Laet I, et al. WSACS--The Abdominal Compartment Society. A Society dedicated to the study of the physiology and pathophysiology of the abdominal compartment and its interactions with all organ systems. Anaesth Intensive Ther. 2015;47(3):191–4.CrossRefGoogle Scholar
  39. 39.
    Cheatham ML, Safcsak K. Is the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival? Crit Care Med. 2010;38(2):402–7.CrossRefPubMedGoogle Scholar
  40. 40.
    Cheatham ML, Safcsak K, Llerena LE, et al. Long-term physical, mental, and functional consequences of abdominal decompression. J Trauma. 2004;56(2):237–41.CrossRefPubMedGoogle Scholar
  41. 41.
    Balogh ZJ, Martin A, van Wessem KP, et al. Mission to eliminate postinjury abdominal compartment syndrome. Arch Surg. 2011;146(8):938–43.CrossRefPubMedGoogle Scholar
  42. 42.
    Pruitt BA Jr. Protection from excessive resuscitation: “pushing the pendulum back”. J Trauma. 2000;49(3):567.CrossRefPubMedGoogle Scholar
  43. 43.
    Joseph B, Azim A, Zangbar B, et al. Improving mortality in trauma laparotomy through the evolution of damage control resuscitation: analysis of 1,030 consecutive trauma laparotomies. J Trauma Acute Care Surg. 2016.Google Scholar
  44. 44.
    Wise R, Roberts DJ, Vandervelden S, et al. Awareness and knowledge of intra-abdominal hypertension and abdominal compartment syndrome: results of an international survey. Anaesth Intensive Ther. 2014.Google Scholar
  45. 45.
    Strang SG, Van Lieshout EM, Verhoeven RA, et al. Recognition and management of intra-abdominal hypertension and abdominal compartment syndrome; a survey among Dutch surgeons. Eur J Trauma Emerg Surg. 2016;43(1):85–98.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Zhou JC, Zhao HC, Pan KH, et al. Current recognition and management of intra-abdominal hypertension and abdominal compartment syndrome among tertiary Chinese intensive care physicians. J Zhejiang Univ Sci B. 2011;12(2):156–62.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Kaussen T, Steinau G, Srinivasan PK, et al. Recognition and management of abdominal compartment syndrome among German pediatric intensivists: results of a national survey. Ann Intensive Care. 2012;2(Suppl 1):S8.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Hunt L, Frost SA, Newton PJ, et al. A survey of critical care nurses’ knowledge of intra-abdominal hypertension and abdominal compartment syndrome. Aust Crit Care. 2016; pii: S1036-7314(16)00030-8.Google Scholar
  49. 49.
    van Hensbroek PB, Wind J, Dijkgraaf MGW, et al. Temporary closure of the open abdomen: a systematic review on delayed primary fascial closure in patients with an open abdomen. World J Surg. 2009;33(2):199–207.CrossRefGoogle Scholar
  50. 50.
    Acosta S, Bjarnason T, Petersson U, et al. Multicentre prospective study of fascial closure rate after open abdomen with vacuum and mesh-mediated fascial traction. Br J Surg. 2011;98(5):735–43.CrossRefPubMedGoogle Scholar
  51. 51.
    Teixeira PGR, Salim A, Inaba K, et al. A prospective look at the current state of open abdomens. Am Surg. 2008;74(10):891–7.PubMedGoogle Scholar
  52. 52.
    Miller RS, Morris JA, Diaz JJ, et al. Complications after 344 damage-control open celiotomies. J Trauma. 2005;59(6):1365–71.CrossRefPubMedGoogle Scholar
  53. 53.
    Schecter WP, Ivatury RR, Rotondo MF, Hirshberg A. Open abdomen after trauma and abdominal sepsis: a strategy for management. J Am Coll Surg. 2006;203(3):390–6.CrossRefPubMedGoogle Scholar
  54. 54.
    Campbell A, Chang M, Fabian T, et al. Management of the open abdomen: from initial operation to definitive closure. Am Surg. 2009;75(11 Suppl):S1–22.PubMedGoogle Scholar
  55. 55.
    Bee TK, Croce MA, Magnotti LJ, et al. Temporary abdominal closure techniques: a prospective randomized trial comparing polyglactin 910 mesh and vacuum-assisted closure. J Trauma. 2008;65(2):337–42. discussion 342–4CrossRefPubMedGoogle Scholar
  56. 56.
    Vertrees A, Greer L, Pickett C, et al. Modern management of complex open abdominal wounds of war: a 5-year experience. J Am Coll Surg. 2008;207(6):801–9.CrossRefPubMedGoogle Scholar
  57. 57.
    Pliakos I, Papavramidis TS, Mihalopoulos N, et al. Vacuum-assisted closure in severe abdominal sepsis with or without retention sutured sequential fascial closure: a clinical trial. Surgery. 2010;148(5):947–53.CrossRefPubMedGoogle Scholar
  58. 58.
    Brock WB, Barker DE, Burns RP. Temporary closure of open abdominal wounds: the vacuum pack. Am Surg. 1995;61(1):30–5.PubMedGoogle Scholar
  59. 59.
    Barker DE, Green JM, Maxwell RA, et al. Experience with vacuum-pack temporary abdominal wound closure in 258 trauma and general and vascular surgical patients. J Am Coll Surg. 2007;204(5):784–92.CrossRefPubMedGoogle Scholar
  60. 60.
    Miller PR, Thompson JT, Faler BJ, et al. Late fascial closure in lieu of ventral hernia: the next step in open abdomen management. J Trauma. 2002;53(5):843–9.CrossRefPubMedGoogle Scholar
  61. 61.
    Garner GB, Ware DN, Cocanour CS, et al. Vacuum-assisted wound closure provides early fascial reapproximation in trauma patients with open abdomens. Am J Surg. 2001;182:630–8.CrossRefPubMedGoogle Scholar
  62. 62.
    Miller PR, Meredith JW, Johnson JC, Chang MC. Prospective evaluation of vacuum-assisted fascial closure after open abdomen. Ann Surg. 2004;239(5):608–16.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Cothren CC, Moore EE, Johnson JL, et al. One hundred percent fascial approximation with sequential abdominal closure of the open abdomen. Am J Surg. 2006;192(2):238–42.CrossRefPubMedGoogle Scholar
  64. 64.
    Amin AI. Topical negative pressure in managing severe peritonitis: a positive contribution? World J Gastroenterol. 2009;15(27):3394.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Padalino P, Dionigi G, Minoja G, et al. Fascia-to-fascia closure with abdominal topical negative pressure for severe abdominal infections: preliminary results in a department of general surgery and intensive care unit. Surg Infect. 2010;11(6):523–8.CrossRefGoogle Scholar
  66. 66.
    Cheatham ML, Demetriades D, Fabian TC, 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(9):2018–30.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Kirkpatrick AW, Roberts DJ, Faris PD. Active negative pressure peritoneal therapy after abbreviated laparotomy: the intraperitoneal vacuum randomized controlled trial. Ann Surg. 2015;262(1):38–46.CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Bruhin A, Ferreira F, Chariker M, et al. Systematic review and evidence based recommendations for the use of negative pressure wound therapy in the open abdomen. Int J Surg. 2014;12(10):1105–14.CrossRefPubMedGoogle Scholar
  69. 69.
    Björck M, Kirkpatrick AW, Cheatham M, et al. Amended classification of the open abdomen. Scand J Surg. 2016;105(1):5–10.CrossRefPubMedGoogle Scholar
  70. 70.
    Coccolini F, Catena F, Montori G, et al. IROAM: the International Register of Open Abdomen.: an international effort to better understand the open abdomen: call for participants. World J Emerg Surg. 2015;10:37.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Diaz JJ Jr, Cullinane DC, Dutton WD, et al. The management of the open abdomen in trauma and emergency general surgery: part 1-damage control. J Trauma. 2010;68(6):1425–38.CrossRefPubMedGoogle Scholar
  72. 72.
    Diaz JJ Jr, Dutton WD, Ott MM, et al. Eastern Association for the Surgery of Trauma: a review of the management of the open abdomen--part 2 “management of the open abdomen”. J Trauma. 2011;71(2):502–12.CrossRefPubMedGoogle Scholar
  73. 73.
    Diaz JJ Jr, Cullinane DC, Khwaja KA, et al. Eastern Association for the Surgery of Trauma: management of the open abdomen, part III-review of abdominal wall reconstruction. J Trauma Acute Care Surg. 2013;75(3):376–86.CrossRefPubMedGoogle Scholar
  74. 74.
    Dubose JJ, Scalea TM, Holcomb JB, et al. Open abdominal management after damage-control laparotomy for trauma: a prospective observational American Association for the Surgery of Trauma multicenter study. J Trauma Acute Care Surg. 2013;74(1):113–20.CrossRefPubMedGoogle Scholar
  75. 75.
    Bradley MJ, Dubose JJ, Scalea TM, et al. Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy: results from the prospective AAST Open Abdomen registry. JAMA Surg. 2013;148(10):947–54.CrossRefPubMedGoogle Scholar
  76. 76.
    Pommerening MJ, DuBose JJ, Zielinski MD, et al. Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy. Surgery. 2014;156(2):431.CrossRefPubMedGoogle Scholar
  77. 77.
    Chiara O, Cimbanassi S, Biffl W, et al. International consensus conference on open abdomen in trauma. J Trauma Acute Care Surg. 2016;80(1):173–83.CrossRefPubMedGoogle Scholar
  78. 78.
    Sartelli M, Abu-Zidan FM, Ansaloni L, et al. The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper. World J Emerg Surg. 2015;10:35.CrossRefPubMedPubMedCentralGoogle Scholar
  79. 79.
    Bruns BR, Ahmad SA, OʼMeara L, et al. Nontrauma open abdomens: a prospective observational study. J Trauma Acute Care Surg. 2016;80(4):631–6.CrossRefPubMedGoogle Scholar
  80. 80.
    Loftus TJ, Jordan JR, Croft CA, et al. Temporary abdominal closure for trauma and intra-abdominal sepsis: different patients, different outcomes. J Trauma Acute Care Surg. 2016. [Epub ahead of print].Google Scholar
  81. 81.
    Cristaudo A, Jennings SB, Hitos K, et al. Treatments and other prognostic factors in the management of the open abdomen: a systematic review. Published Ahead-of-Print Nov 2016 JTACS.Google Scholar
  82. 82.
    Atema JJ, de Vries FE, Boermeester MA. Systematic review and meta-analysis of the repair of potentially contaminated and contaminated abdominal wall defects. Am J Surg. 2016;212(5):982–95.CrossRefPubMedGoogle Scholar
  83. 83.
    Schein M. In: Ivatury R, Cheatham M, Malbrain M, Sugrue M, editors. Abdominal Compartment Syndrome. WSACS; 2006. p. 5.Google Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryVirginia Commonwealth UniversityRichmondUSA

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