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Abdominal content containment: practicalities and outcome.

F Ghimenton1, S R Thomson, D J Muckart

  • 1Department of Surgery and Anaesthesia, University of Natal, Durban, South Africa.

The British Journal of Surgery
|December 22, 1999
PubMed
Summary
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Temporary abdominal content containment (t-ACC) using plastic bags or mesh is used for critically ill patients. Survivors often face long hospital stays and incisional hernias, requiring complex repairs.

Area of Science:

  • Surgical critical care
  • Abdominal surgery
  • Trauma surgery

Background:

  • Temporary abdominal content containment (t-ACC) is an alternative to fascial closure for critically ill patients.
  • Management of t-ACC presents practical and logistical challenges.

Purpose of the Study:

  • To describe the outcomes and challenges associated with temporary abdominal content containment (t-ACC).
  • To compare the effectiveness and cost of plastic bags versus polyglactin mesh for t-ACC.

Main Methods:

  • A single-institution study of 157 patients (100 trauma, 57 non-trauma) between 1994-1997.
  • Patients underwent t-ACC using plastic bags or polyglactin mesh for indications like sepsis, abdominal compartment syndrome, or tissue loss.
  • A total of 385 laparotomies were performed.

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Main Results:

  • Two t-ACC procedures failed technically; two cases developed enteric fistulas.
  • Six patients had early definitive closure; survivors experienced prolonged hospital stays (mean 44.6 days).
  • All survivors developed incisional hernias requiring complex repair; overall mortality was 44%.

Conclusions:

  • Plastic bags were found to be cheaper and as effective as polyglactin mesh for t-ACC.
  • Survivors necessitate a multidisciplinary approach, prolonged hospitalization, and subsequent complex incisional hernia repair.