The Open Abdomen: Indications and Management
Over the last 20 years, the therapeutic ‘open abdomen’ (OA) has become more widely used. It can be a useful tool in the treatment of the abdominal catastrophe. New techniques for its management have been developed, and outcomes are improving.
Many indications for open abdomen have been described, but OA should be considered as a therapeutic measure to use in specific situations. Primary abdominal closure should be carried out whenever possible, even if further laparotomy may be needed.
When contemplating leaving the abdomen open, the surgeon should already have a management plan for the short, medium and long term. This must include aims at preventing and managing the significant morbidity and complications relating to the underlying condition as well as the management of the open abdominal wound itself.
Temporary abdominal closure (TAC) has evolved as OA has been more widely used and understood. This has been associated with advances in wound management techniques and equipment. The TAC methods, if correctly used, can prevent the lateralization of recti and fixity of the abdominal wall which should allow fascial closure to be achieved once the underlying condition has resolved.
If complete fascial closure is not achieved at the index admission, definitive abdominal fascial closure may take many months to achieve, and some patients may choose to live with a residual hernia, rather than subject themselves to further surgery.
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