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Emergent abdominal decompression with patch abdominoplasty in the pediatric patient
H L Neville1, K P Lally, C S Cox
1Department of Surgery, University of Texas-Houston Medical School and the Memorial-Hermann Children's Hospital, USA.
Insights
Patch abdominoplasty (PA) effectively treats pediatric abdominal compartment syndrome (ACS) by reducing airway pressures and oxygen needs. Complications are mainly seen in necrotizing enterocolitis (NEC) patients, and a lack of PIP improvement is a poor prognostic sign.
Area of Science:
- Pediatric Surgery
- Critical Care Medicine
- Abdominal Compartment Syndrome
Background:
- Abdominal compartment syndrome (ACS) involves multi-organ dysfunction due to elevated intra-abdominal pressure.
- Patch abdominoplasty (PA) is explored as a treatment for pediatric ACS.
Purpose of the Study:
- To evaluate the effectiveness of PA in treating and preventing ACS in pediatric patients.
- To identify patient groups at higher risk for complications.
Main Methods:
- Retrospective chart review of pediatric patients who underwent PA.
- ACS defined by increased oxygen needs, peak inspiratory pressures (PIP), abdominal distension, and worsening organ function.
- Analysis of pre- and post-operative respiratory and renal parameters.
Main Results:
- 23 pediatric patients treated; common diagnoses include necrotizing enterocolitis (NEC) and trauma.
- PA significantly decreased oxygen requirements (FIO2) and PIP in survivors.
- Non-survivors (primarily NEC patients) showed no significant PIP improvement.
- Intra-abdominal abscess and enterocutaneous fistula complications occurred in 5 NEC patients.
Conclusions:
- Patch abdominoplasty is effective in decreasing airway pressures and oxygen needs in pediatric ACS.
- Complications associated with PA are predominantly observed in patients with NEC.
- Failure of PIP and FIO2 to decrease post-PA indicates a poor prognosis.
Background/Purpose:
Abdominal compartment syndrome (ACS) is the cardiac, pulmonary, and renal dysfunction that occurs as a result of elevated intraabdominal pressure. The authors present their experience with patch abdominoplasty (PA) in pediatric patients as a means to treat and prevent ACS.
Methods:
The charts of patients who underwent PA were reviewed retrospectively. ACS was defined as the increased oxygen requirements and elevation of peak inspiratory pressures (PIP) associated with abdominal distension and worsening renal and or cardiac function.
Results:
A total of 23 patients (13 boys) were treated (average age, 23 months). Diagnoses included necrotizing enterocolitis (NEC, n = 13), trauma (n = 3), Hirschsprung's enterocolitis (n = 2), perforated bowel (n = 4), and bilateral Wilms' tumor with bowel obstruction (n = 1). Oxygen requirements decreased after patch abdominoplasty (mean preoperative FIO2, 0.87 +/- 24, mean postoperative, 0.67 +/- 24 [P = .01]). The PIP decreased significantly in the 13 patients who survived (mean preoperative PIP, 33 +/- 8, mean postoperative PIP, 27 +/- 7 [P = .01]). These PIPs failed to respond in the 8 nonsurvivors (mean preoperative PIP, 35 +/- 10, mean postoperative PIP, 33 +/- 14 [P value not significant]). Six of the 8 nonsurvivors had NEC. Complications of intraabdominal abscess and enterocutaneous fistula were seen in 5 patients, all of who had NEC.
Conclusions:
Patch abdominoplasty effectively decreases airway pressures and oxygen requirements associated with ACS. Complications with PA occur primarily in patients with NEC. Failure to respond with a decrease in PIP and FIO2 requirements is an ominous sign.