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Ottolino P. Managing the Open Abdomen: Selecting an Appropriate Treatment Strategy. Adv Wound Care (New Rochelle) 2024; 13:400-415. [PMID: 38963339 DOI: 10.1089/wound.2023.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024] Open
Abstract
Significance: The laparotomy is a common surgical procedure with a wide range of indications. Ideally, once the goals of surgery were achieved, the incision edges could then be approximated and the abdomen primarily closed. However, in some circumstances, it may be impossible to achieve primary closure, and instead the abdomen is intentionally left open. This review discusses the indications and objectives for the open abdomen (OA), summarizes the most common techniques for temporary abdominal closure, and illustrates treatment algorithms grounded in the current recommendations from specialty experts. Recent Advances: Still a relatively young technique, multiple strategies, and technologies have emerged to manage the OA. So too have the recommendations evolved, based on updated classifications that take wound characteristics into account. Recent studies have also brought greater clarity on recommendations for managing infection and malnutrition to support improved clinical outcomes. Critical Issues: The status of the OA can change rapidly depending on the patient's condition, the wound quality, and many other factors. Thus, there is a significant need for comprehensive treatment strategies that can be adapted to these developing circumstances. Future Directions: Treatment recommendations should be continuously updated as new technologies are introduced and old techniques fall out of use.
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Popivanov G, Cirocchi R, Penchev D, Kjossev K, Konaktchieva M, Mutafchiyski V. Successful Negative Pressure Therapy of Enteroatmospheric Fistula after Right Colectomy for Complicated Crohn’s Disease —A Proposal for a Three-Drain Wound-Separation Technique. Medicina (B Aires) 2022; 58:medicina58020199. [PMID: 35208523 PMCID: PMC8880797 DOI: 10.3390/medicina58020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/30/2022] Open
Abstract
Enteroatmospheric fistulas (EAFs) are still the worst complication of the open abdomen. They lead to a significantly prolonged intensive care unit and hospital stay and to high mortality. Despite the various techniques described in the literature EAFs remain “a nightmare” for the patient, the surgeon, and the hospital. Here we describe a case of right colectomy for obstructing Crohn’s disease in a 26-year-old. On the 19th postoperative day, he developed a superficial EAF. Due to the frozen abdomen, neither resection of the anastomosis, nor implementation of the known techniques for treatment of EAFs were possible. This prompted us to modify the Pepe technique. The EAF was isolated from the upper and lower parts of the wound through deep-skin and subcutaneous sutures and the application of two small pieces of non-adherent plastic foil. The lower holes of a single drain, put through a piece of black foam, were placed over the fistula. The upper holes, which were enveloped with the foam, remained in contact with the wound. The drain was connected to a negative pressure of 125 mmHg. NPWT (negative pressure wound therapy) was also applied by two separate sponges and drains in the upper and lower part. The mainstay of EAF treatment is the isolation of the EAF from the abdominal cavity and subcutaneous tissue, supported by control of the sepsis and adequate nutrition. The proposed technique is applicable in cases with a single, superficial EAF on the background of the frozen abdomen with minimal lateral fascial retraction. As of today, due to the rarity of the condition and lack of randomized trials, EAFs still represents a unique challenge often requiring improvisation.
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Affiliation(s)
- Georgi Popivanov
- Department of Surgery, Military Medical Academy, “Sv. G. Sofiiski” Str. 3, 1606 Sofia, Bulgaria; (D.P.); (K.K.); (V.M.)
- Correspondence: ; Tel.: +359-885-521-241; Fax: +359-2-95-26-536
| | - Roberto Cirocchi
- Department of Surgical Science, University of Perugia, 06123 Perugia, Italy;
| | - Dimitar Penchev
- Department of Surgery, Military Medical Academy, “Sv. G. Sofiiski” Str. 3, 1606 Sofia, Bulgaria; (D.P.); (K.K.); (V.M.)
| | - Kirien Kjossev
- Department of Surgery, Military Medical Academy, “Sv. G. Sofiiski” Str. 3, 1606 Sofia, Bulgaria; (D.P.); (K.K.); (V.M.)
| | - Marina Konaktchieva
- Department of Gastroenterology, Hepatology and Transplantology, Military Medical Academy, “Sv. G. Sofiiski” Str. 3, 1606 Sofia, Bulgaria;
| | - Ventsislav Mutafchiyski
- Department of Surgery, Military Medical Academy, “Sv. G. Sofiiski” Str. 3, 1606 Sofia, Bulgaria; (D.P.); (K.K.); (V.M.)
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Goh EL, Chidambaram S, Segaran E, Garnelo Rey V, Khan MA. A meta-analysis of the outcomes following enteral vs parenteral nutrition in the open abdomen in trauma patients. J Crit Care 2019; 56:42-48. [PMID: 31837600 DOI: 10.1016/j.jcrc.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 10/23/2019] [Accepted: 12/02/2019] [Indexed: 11/16/2022]
Affiliation(s)
- En Lin Goh
- Faculty of Medicine, Imperial College London, South Kensington, London SW7 2AZ, United Kingdom.
| | - Swathikan Chidambaram
- Faculty of Medicine, Imperial College London, South Kensington, London SW7 2AZ, United Kingdom.
| | - Ella Segaran
- Department of Surgery and Trauma, Imperial College London, St Mary's Hospital, W2 1NY London, United Kingdom.
| | - Vanesa Garnelo Rey
- Department of Surgery and Trauma, Imperial College London, St Mary's Hospital, W2 1NY London, United Kingdom.
| | - Mansoor Ali Khan
- Department of Surgery and Trauma, Imperial College London, St Mary's Hospital, W2 1NY London, United Kingdom.
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Martin-Loeches I, Timsit JF, Leone M, de Waele J, Sartelli M, Kerrigan S, Azevedo LCP, Einav S. Clinical controversies in abdominal sepsis. Insights for critical care settings. J Crit Care 2019; 53:53-58. [DOI: 10.1016/j.jcrc.2019.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 12/27/2022]
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Coccolini F, Ceresoli M, Kluger Y, Kirkpatrick A, Montori G, Salvetti F, Fugazzola P, Tomasoni M, Sartelli M, Ansaloni L, Catena F, Negoi I, Zese M, Occhionorelli S, Shlyapnikov S, Galatioto C, Chiarugi M, Demetrashvili Z, Dondossola D, Ioannidis O, Novelli G, Nacoti M, Khor D, Inaba K, Demetriades D, Kaussen T, Jusoh AC, Ghannam W, Sakakushev B, Guetta O, Dogjani A, Costa S, Singh S, Damaskos D, Isik A, Yuan KC, Trotta F, Rausei S, Martinez-Perez A, Bellanova G, Fonseca V, Hernández F, Marinis A, Fernandes W, Quiodettis M, Bala M, Vereczkei A, Curado R, Fraga GP, Pereira BM, Gachabayov M, Chagerben GP, Arellano ML, Ozyazici S, Costa G, Tezcaner T, Porta M, Li Y, Karateke F, Manatakis D, Mariani F, Lora F, Sahderov I, Atanasov B, Zegarra S, Gianotti L, Fattori L, Ivatury R. Open abdomen and entero-atmospheric fistulae: An interim analysis from the International Register of Open Abdomen (IROA). Injury 2019; 50:160-166. [PMID: 30274755 DOI: 10.1016/j.injury.2018.09.040] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/26/2018] [Accepted: 09/20/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION No definitive data describing associations between cases of Open Abdomen (OA) and Entero-atmospheric fistulae (EAF) exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) thus analyzed the International Register of Open Abdomen (IROA) to assess this question. MATERIAL AND METHODS A prospective analysis of adult patients enrolled in the IROA. RESULTS Among 649 adult patients with OA 58 (8.9%) developed EAF. Indications for OA were peritonitis (51.2%) and traumatic-injury (16.8%). The most frequently utilized temporary abdominal closure techniques were Commercial-NPWT (46.8%) and Bogotà-bag (21.9%). Mean OA days were 7.9 ± 18.22. Overall mortality rate was 29.7%, with EAF having no impact on mortality. Multivariate analysis associated cancer (p = 0.018), days of OA (p = 0.003) and time to provision-of-nutrition (p = 0.016) with EAF occurrence. CONCLUSION Entero-atmospheric fistulas are influenced by the duration of open abdomen treatment and by the nutritional status of the patient. Peritonitis, intestinal anastomosis, negative pressure and oral or enteral nutrition were not risk factors for EAF during OA treatment.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy.
| | - Marco Ceresoli
- General and Emergency Surgery, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy.
| | - Yoram Kluger
- Division of General Surgery Rambam Health Care Campus Haifa, Israel.
| | | | - Giulia Montori
- General Surgery, San Giovanni Bianco Hospital, Bergamo, Italy.
| | - Fracensco Salvetti
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy.
| | - Paola Fugazzola
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy.
| | - Matteo Tomasoni
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy.
| | - Massimo Sartelli
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy.
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy.
| | - Fausto Catena
- Emergency Surgery dept., Parma University Hospital, Parma, Italy.
| | - Ionut Negoi
- Emergency Surgery Hospital, Bucharest, Romania
| | - Monica Zese
- Emergency Surgery dept. Ferrara University Hospital, Ferrara, Italy
| | | | | | | | | | | | - Daniele Dondossola
- HPB Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Orestis Ioannidis
- Fourth Surgical dept. Hospital George Papanikolau, Aristotle University, Thessaloniki, Greece
| | | | - Mirco Nacoti
- Pediatric Intensive Care Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Kenji Inaba
- LAS+USC Medical Centre, Los Angeles, California
| | | | - Torsten Kaussen
- Pediatric Intensive Care Unit, Hannover University Hospital, Hannover, Germany
| | | | | | | | | | | | - Stefano Costa
- Emergency and General Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | - Arda Isik
- Erzincan University Faculty Of Medicine MengucekGazi Training Research Hospital Erzincan, Turkey
| | | | | | - Stefano Rausei
- Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | | | | | | | | | | | | | | | - Miklosh Bala
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | | | | | | | | | | | | | - Sefa Ozyazici
- Adana Numune Training and Research Hospital, Department of Surgery, Adana, Turkey
| | - Gianluca Costa
- Ospedale Sant'Andrea University Hospital Sapienza, Rome, Italy
| | | | - Matteo Porta
- General Surgery, IRCCS Policlinico San Donato, Milano, Italy
| | - Yousheng Li
- Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Faruk Karateke
- Numune Training and Research Hospital, Department of Surgery, Numune, Turkey
| | | | - Federico Mariani
- General Surgery, Santa Maria alleScotteUniversitary Hospital Siena, Italy
| | - Federic Lora
- General Surgery, Cittàdella Salute e dellascienza, Torino, Italy
| | - Ivan Sahderov
- General Surgery, Krasnoyarsk Regional Hospital, Krasnoyarsk, Russia
| | | | | | - Luca Gianotti
- General and Emergency Surgery, Milano-Bicocca University School of Medicine and surgery, Monza, Italy
| | - Luca Fattori
- General and Emergency Surgery, Milano-Bicocca University School of Medicine and surgery, Monza, Italy
| | - Rao Ivatury
- Virginia Commonwealth University, Richmond, Virginia, USA
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Bower KL, Collier BR. Update on Feeding the Open Abdomen in the Trauma Patient. CURRENT SURGERY REPORTS 2018. [DOI: 10.1007/s40137-018-0212-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Yandell R, Wang S, Bautz P, Shanks A, O'Connor S, Deane A, Lange K, Chapman M. A retrospective evaluation of nutrition support in relation to clinical outcomes in critically ill patients with an open abdomen. Aust Crit Care 2018; 32:237-242. [PMID: 29903605 DOI: 10.1016/j.aucc.2018.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Optimising nutrition support in critically ill patients with an open abdomen is challenging. OBJECTIVES The aims of this study were to (i) quantify the amount and adequacy of nutrition support administered and (ii) determine any relationships that exist between mode of nutrition support delivery and clinical outcomes in critically ill patients with an open abdomen. METHODS A retrospective review of critically ill patients mechanically ventilated for at least 48 h with an open abdomen in a mixed quaternary referral intensive care unit. Enteral and parenteral nutrition (ml) administered daily to patients was recorded for up to 21 days. Length of stay in the intensive care unit and hospital and duration of mechanical ventilation (days) were reported. RESULTS Thirty patients were studied [14 male, 68 y (15-90 y), body mass index 25 kg/m2 (11-51 kg/m2), Acute Physiology and Chronic Health Evaluation II score 20 (7-41), energy goal 1860 kcal/d (1250-2712 kcal/d)]. Patients received 55% (0-117%) of energy goal and 56% (0-105%) protein goal from either enteral or parenteral nutrition. When enteral nutrition was delivered alone or in combination with parenteral nutrition, patients received 48% (0-146%) of their energy and 59% (19-105%) of their protein goal. Patients fed parenteral nutrition, either alone or as supplementary to enteral nutrition (n = 18), received more energy when compared with those who only received enteral nutrition (n = 9) [65 (27-117) vs 49 (15-89) % energy goal, P = 0.025]. Parenteral nutrition was associated with an increased length of stay in hospital [63 (45-156) vs 45 (17-93) d, P = 0.037]. CONCLUSION Patients with an open abdomen receive about half of their nutrition requirements when fed exclusively via the enteral route. Providing combination enteral and parenteral nutrition to reach nutritional goals may not result in better clinical outcomes for patients with an open abdomen.
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Affiliation(s)
- Rosalie Yandell
- Department of Nutrition and Dietetics, Trauma Services, Royal Adelaide Hospital, Port Rd, Adelaide, 5000, Australia; Centre of Clinical Research Excellence (CRE) in Translating Science to Good Health, The University of Adelaide, Frome Rd, Adelaide, 5000, Australia; Discipline of Acute Care Medicine, The University of Adelaide, Frome Rd, Adelaide, 5000, Australia.
| | - Susan Wang
- Department of Critical Care Services, Trauma Services, Royal Adelaide Hospital, Port Rd, Adelaide, 5000, Australia
| | - Peter Bautz
- Hepatobiliary Surgery, Trauma Services, Royal Adelaide Hospital, Port Rd, Adelaide, 5000, Australia
| | - Alison Shanks
- Department of Nutrition and Dietetics, Trauma Services, Royal Adelaide Hospital, Port Rd, Adelaide, 5000, Australia
| | - Stephanie O'Connor
- Department of Critical Care Services, Trauma Services, Royal Adelaide Hospital, Port Rd, Adelaide, 5000, Australia; Discipline of Acute Care Medicine, The University of Adelaide, Frome Rd, Adelaide, 5000, Australia
| | - Adam Deane
- Department of Critical Care Services, Trauma Services, Royal Adelaide Hospital, Port Rd, Adelaide, 5000, Australia; Centre of Clinical Research Excellence (CRE) in Translating Science to Good Health, The University of Adelaide, Frome Rd, Adelaide, 5000, Australia; Discipline of Acute Care Medicine, The University of Adelaide, Frome Rd, Adelaide, 5000, Australia
| | - Kylie Lange
- Centre of Clinical Research Excellence (CRE) in Translating Science to Good Health, The University of Adelaide, Frome Rd, Adelaide, 5000, Australia
| | - Marianne Chapman
- Department of Critical Care Services, Trauma Services, Royal Adelaide Hospital, Port Rd, Adelaide, 5000, Australia; Centre of Clinical Research Excellence (CRE) in Translating Science to Good Health, The University of Adelaide, Frome Rd, Adelaide, 5000, Australia; Discipline of Acute Care Medicine, The University of Adelaide, Frome Rd, Adelaide, 5000, Australia
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8
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Du Toit A. SASPEN Case Study: Nutritional management of a patient with an open abdomen. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2016. [DOI: 10.1080/16070658.2014.11734502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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VAWCM-Instillation Improves Delayed Primary Fascial Closure of Open Septic Abdomen. Gastroenterol Res Pract 2014; 2014:245182. [PMID: 25548553 PMCID: PMC4273477 DOI: 10.1155/2014/245182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 11/18/2014] [Indexed: 01/14/2023] Open
Abstract
Background. Failure to achieve delayed primary fascial closure (DPFC) is one of the main complications of open abdomen (OA), certainly when abdominal sepsis is present. This retrospective cohort study aims to evaluate the effect of combined therapy of vacuum-assisted mesh-mediated fascial traction and topical instillation (VAWCM-instillation) on DPFC in the open septic abdomen. Methods. The patients with abdominal sepsis who underwent OA using VAWCM were included and divided into the instillation and noninstillation (control) groups. The DPFC rate and other outcomes were compared between the two groups. Results. Between 2007 and 2013, 73 patients with open septic abdomen were treated with VAWCM-instillation and 61 cases with VAWCM-only. The DPFC rate in the instillation group was significantly increased (63% versus 41%, P = 0.011). The mortality with OA was similar (24.6% versus 23%, P = 0.817) between the two groups. However, time to DPFC (P = 0.003) and length of stay in hospital (P = 0.022) of the survivals were significantly decreased in the instillation group. In addition, VAWCM-instillation (OR 1.453, 95% CI 1.222–4.927, P = 0.011) was an independent influencing factor related to successful DPFC. Conclusions. VAWCM-instillation could improve the DPFC rate but could not decrease the mortality in the patients with open septic abdomen.
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Surgical management of a retrohepatic inferior vena cava injury following blunt abdominal trauma. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Martindale RG, McClave SA, Taylor B, Lawson CM. Perioperative nutrition: what is the current landscape? JPEN J Parenter Enteral Nutr 2014; 37:5S-20S. [PMID: 24009250 DOI: 10.1177/0148607113496821] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Poor nutrition status has long been linked to increases in postoperative complications and adverse outcomes for the patient undergoing elective surgery. While optimal planning for nutrition therapy should be comprehensive spanning throughout the perioperative period, recent advances have focused on the concept of "prehabilitation" to best prepare the patient prior to the insult of surgery. Adding immune/metabolic modulating formulas the week of surgery with carbohydrate drinks to optimize glycogen deposition immediately prior to surgery, enhances patient recovery and return to baseline function. Such nutrition strategies should now be combined with a host of other practices (such as smoking cessation, weight loss, glucose control, and specialized exercise program) as part of a structured protocol to maximize patients' chances for a full and rapid recovery from their elective surgical procedure.
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Affiliation(s)
- Robert G Martindale
- Department of Surgery, University of Oregon Health Sciences University, Portland, Oregon, USA
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Ren J, Yuan Y, Zhao Y, Gu G, Wang G, Chen J, Fan C, Wang X, Li J. Open Abdomen Treatment for Septic Patients with Gastrointestinal Fistula: From Fistula Control to Definitive Closure. Am Surg 2014. [DOI: 10.1177/000313481408000414] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The use of open abdomen in the management of gastrointestinal fistula complicated with severe intra-abdominal infection is uncommon. This study was designed to evaluate outcomes of our staged approach for the infected open abdomen. Patients who had gastrointestinal fistula and underwent open abdomen treatment were retrospectively reviewed. Various materials such as polypropylene mesh and a modified sandwich package were used to achieve temporary abdominal closure followed by skin grafting when the granulation bed matured. A delayed definitive operation was performed for final abdominal closure without implant of prosthetic mesh. Between 1999 and 2009, 56 (68.3%) of 82 patients survived through this treatment. Among them, 42 patients achieved final abdominal closure. Spontaneous fistula closure occurred in 16 patients with secondary fistula recorded in six patients. Besides, wound complications occurred in 13 patients with two cases for pulmonary infection. Within a 12-month follow-up period after definitive closure, no additional fistula was recorded excluding planned ventral hernia repair. Open abdomen treatment was effective for gastrointestinal fistula complicated by severe intra-abdominal infection. A delayed and deliberate operative strategy aiming at fistula excision and fascial closure, with simultaneous abdominal wall reconstruction, was required for the infected open abdomen.
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Affiliation(s)
- Jianan Ren
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- Department of Gastrointestinal-Pancreatic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yujie Yuan
- Department of Gastrointestinal-Pancreatic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yunzhao Zhao
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Guosheng Gu
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Gefei Wang
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jun Chen
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chaogang Fan
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xinbo Wang
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jieshou Li
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Veldsman L. Saspen Case Study: Intra-abdominal hypertension. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2014. [DOI: 10.1080/16070658.2014.11734491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yuan Y, Ren J, He Y. Current status of the open abdomen treatment for intra-abdominal infection. Gastroenterol Res Pract 2013; 2013:532013. [PMID: 24198827 PMCID: PMC3807717 DOI: 10.1155/2013/532013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 08/31/2013] [Accepted: 09/15/2013] [Indexed: 01/13/2023] Open
Abstract
The open abdomen has become an important approach for critically ill patients who require emergent abdominal surgical interventions. This treatment, originating from the concept of damage control surgery, was first applied in severe traumatic patients. The ultimate goal is to achieve formal abdominal fascial closure by several attempts and adjuvant therapies (fluid management, nutritional support, skin grafting, etc.). Up to the present, open abdomen therapy becomes matured and is multistage-approached in the management of patients with severe trauma. However, its application in patients with intra-abdominal infection still presents great challenges due to critical complications and poor clinical outcomes. This review focuses on the specific use of the open abdomen in such populations and detailedly introduces current concerns and advanced progress about this therapy.
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Affiliation(s)
- Yujie Yuan
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-Sen University, 58 2nd Zhongshan Road, Guangzhou, Guangdong 510080, China
| | - Jianan Ren
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu 210002, China
| | - Yulong He
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-Sen University, 58 2nd Zhongshan Road, Guangzhou, Guangdong 510080, China
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The modified sandwich-vacuum package for fascial closure of the open abdomen in septic patients with gastrointestinal fistula. J Trauma Acute Care Surg 2013; 75:266-72. [DOI: 10.1097/ta.0b013e3182924a63] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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