[Interpretation of the Chinese expert consensus on open abdomen therapy (2023 edition)]

Open abdomen therapy is an effective method for the treatment of severe intra-abdominal infections, abdominal hypertension and other critical abdominal diseases. Bases on systematic reviews of indications, classification and staging of wounds, principles and approaches of open abdomen therapy, abdominal closure measures, and management of enteroatmospheric fistula, the Chinese expert consensus on open abdomen therapy provides 12 recommendations with evidence and specific explanations. This consensus is the first systematic work in China to elaborate on open abdomen therapy, helping clinicians to standardize this technique and improve the treatment outcomes of critical abdominal diseases. In this review, we make interpretations on key points of this consensus one by one.

[Strategies for open abdomen]

This is a review of temporary abdominal closure (TAC) strategies are necessary in cases where definitive surgery is not possible. Indications for TAC include damage control due to unstable physiology, the need for a second look, or lacking technical possibility for fascial closure. The superior method of TAC is vacuum-assisted closure (VAC), with or without a traction mesh. All TAC strategies, including VAC, are associated with an increased number of surgical procedures, increased risk of complications, and prolonged length of stay. TAC should be limited to selected patients and performed by senior surgeons.

Combined management of open abdomen with enteroatmospheric fistula by negative pressure instill wound therapy and dermal matrix wound dressing

AIM

The management of open abdomen with enteroatmospheric fistula is a real nightmare for surgeons; negative pressure with fluid instillation is affordable and effective. After improvement of general conditions, a good strategy for promoting tissue granulation around the fistula could be the application of a matrix wound dressing.

MATERIALS AND METHODS

A 45-year-old man was admitted to our Emergency Department for abdominal compartment syndrome following a previous intervention for bowel occlusion; at exploration we found a frozen abdomen that was managed by negative pressure wound therapy with fluid instillation (AbThera  device, VAC Instill , 3M+KCI). The condition was complicated by an enteroatmospheric fistula that we managed by negative pressure and fistula diversion according to "Baby Bottle Nipple VAC technique". After improvement of general and local conditions, in order to obtain a faster reepithalization around the stoma, we decided to apply a dermal substitute (Integra  Bilayer Wound Matrix, LifeSciences Corporation).

RESULTS

We obtained a good reeepithalization and five months after admittance the patient was dismissed in a good health with a stoma bag applied on the fistula. Six month lather bowel continuity was restored.

CONCLUSIONS

The role of negative pressure with instillation in the management of open abdomen is defined; it allows to preserve healthy bowel integrity and to improve septic environment control. If an enteroatmospheric fistula is present, the application of a dermal substitute can be a good strategy for promoting tissue granulation around the fistula, thus allowing the application of a stoma bag and a faster regain of the upright position.

KEY WORDS

Dermal Substitute, Enteroatmospheric fistula, Negative pressure Wound therapy, Open abdomen.

Treatment of acute diverticulitis with open abdomen technique

AIM

The aim of this study is to highlight our experience about the use of open Abdomen's technique as strategy for the management of complicated colon diverticulitis with a delayed anastomosis or colostomy.

MATERIALS AND METHODS

Thirty patients, with III and IV Hinchey stage, have been undertaken to a surgical procedure with Open Abdomen technique and application of Ab-thera device. A second surgical look was made after 48-72 hours in order to evaluate the possibility to do an anastomosis or colostomy.

RESULTS

No deaths in patients with anastomosis were reported, but one case of leakage at the 8th day and one case of micro pulmonary embolism had been displayed. Elderly patients were discharged between the 15TH /18th day. One patient affected by lymphoma was sent in haematology department for other treatment.

DISCUSSION

Today trend is to treat the diverticular disease with colic and paracolic abscess by a medical therapy and percutaneous drainage under CT scan or ultrasound view. With III and IV of Hinchey scale we perform the resection with anastomosis or colostomy. The open abdomen technique allows the surgeons to make the decision of colostomy or anastomosis in the second surgical look at 48-72 hours after the first treatment with irrigation and aspiration during AB-Thera.

CONCLUSION

The Open Abdomen technique is a valid therapeutic alternative approach for patients with acute diverticulitis disease in III and IV Hinchey grade. This therapeutic approach gives important advantages in patients with delayed colostomy.

KEY WORDS

Diverticulitis, Damage Control Surgery, Open Abdomen.