1
|
Justo I, Marcacuzco A, Caso Ó, Manrique A, García-Sesma Á, Calvo J, Fernández C, Vega V, Rivas C, Jiménez-Romero C. Modified Chevrel technique for abdominal closure in critically ill patients with abdominal hypertension and limited options for closure. Hernia 2023; 27:677-685. [PMID: 37138139 DOI: 10.1007/s10029-023-02797-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/19/2023] [Indexed: 05/05/2023]
Abstract
Abdominal compartment syndrome is a potentially life-threatening condition seen in critically ill patients, and most often caused by acute pancreatitis, postoperative abdominal vascular thrombosis or mesenteric ischemia. A decompressive laparotomy is sometimes required, often resulting in hernias, and subsequent definitive wall closure is challenging. AIM This study aims to describe short term results after a modified Chevrel technique for midline laparotomies in patients witch abdominal hypertension. MATERIALS AND METHODS We performed a modified Chevrel as an abdominal closure technique in 9 patients between January 2016 and January 2022. All patients presented varying degrees of abdominal hypertension. RESULTS Nine patients were treated with new technique (6 male and 3 female), all of whom had conditions that precluded unfolding the contralateral side as a means for closure. The reasons for this were diverse, including presence of ileostomies, intraabdominal drainages, Kher tubes or an inverted T scar from previous transplant. The use of mesh was initially dismissed in 8 of the patients (88,9%) because they required subsequent abdominal surgeries or active infection. None of the patients developed a hernia, although two died 6 months after the procedure. Only one patient developed bulging. A decrease in intrabdominal pressure was achieved in all patients. CONCLUSION The modified Chevrel technique can be used as a closure option for midline laparotomies in cases where the entire abdominal wall cannot be used.
Collapse
Affiliation(s)
- I Justo
- Unit of HPB Surgery and Abdominal Organ Transplantation, Department of Surgery, Faculty of Medicine, Instituto de Investigación (imas12), Complutense University, Madrid, Spain.
| | - A Marcacuzco
- Unit of HPB Surgery and Abdominal Organ Transplantation, Department of Surgery, Faculty of Medicine, Instituto de Investigación (imas12), Complutense University, Madrid, Spain
| | - Ó Caso
- Unit of HPB Surgery and Abdominal Organ Transplantation, Department of Surgery, Faculty of Medicine, Instituto de Investigación (imas12), Complutense University, Madrid, Spain
| | - A Manrique
- Unit of HPB Surgery and Abdominal Organ Transplantation, Department of Surgery, Faculty of Medicine, Instituto de Investigación (imas12), Complutense University, Madrid, Spain
| | - Á García-Sesma
- Unit of HPB Surgery and Abdominal Organ Transplantation, Department of Surgery, Faculty of Medicine, Instituto de Investigación (imas12), Complutense University, Madrid, Spain
| | - J Calvo
- Unit of HPB Surgery and Abdominal Organ Transplantation, Department of Surgery, Faculty of Medicine, Instituto de Investigación (imas12), Complutense University, Madrid, Spain
| | - C Fernández
- Unit of HPB Surgery and Abdominal Organ Transplantation, Department of Surgery, Faculty of Medicine, Instituto de Investigación (imas12), Complutense University, Madrid, Spain
| | - V Vega
- Unit of HPB Surgery and Abdominal Organ Transplantation, Department of Surgery, Faculty of Medicine, Instituto de Investigación (imas12), Complutense University, Madrid, Spain
| | - C Rivas
- Service of Thoracic Surgery and Lung Transplantation, Salamanca University Hospital, Salamanca, Spain
| | - C Jiménez-Romero
- Unit of HPB Surgery and Abdominal Organ Transplantation, Department of Surgery, Faculty of Medicine, Instituto de Investigación (imas12), Complutense University, Madrid, Spain
| |
Collapse
|