Skin only or silo closure in the critically ill patient with an open abdomen
L N Tremblay1, D V Feliciano, J Schmidt
1Department of Surgery, Grady Memorial Hospital and Emory University School of Medicine, 69 Butler St. S.E., Suite 304, Atlanta, GA 30303, USA.
Background:
The morbidity and mortality of various open abdominal techniques remains unclear.
Methods:
A retrospective review was made of all trauma or general surgery patients who underwent an open abdominal closure from January 1997 to December 2000, at a large urban acute care hospital. Data are mean +/- SD.
Results:
From 1997 to 2000, 181 patients (aged 39.8 +/- 16.5 years) had an open abdomen for abdominal infection, planned reexploration, abdominal compartment syndrome, inability to reapproximate fascia, or as part of a "damage control" procedure. Twenty-three patients went on to develop an abdominal compartment syndrome. Gastrointestinal fistulas occurred in 26 patients, and 9 patients had a dehiscence. The overall mortality was 44.7%. Of the survivors, 52% went on to fascial closure, requiring 1 to 7 additional abdominal operations.
Conclusions:
The morbidity of the open abdomen varies with the particular indication. Gastrointestinal fistulas are the most common acute complication and an abdominal wall hernia, the most common chronic complication.
