Related Experiment Videos
Intra-abdominal pressure: a reliable criterion for laparostomy closure?
A Schachtrupp1, J Höer, C Töns
1Department of Surgery, Rhenish Westphalian Technical University, Pauwelsstrasse 30, 52074 Aachen, Germany. Alexander.Schachtrupp@post.rwth-aachen.de
Hernia : the Journal of Hernias and Abdominal Wall Surgery
|September 5, 2002
Summary
Fascial closure after laparostomy increases intra-abdominal pressure (IAP) but appears safe, with no abdominal compartment syndrome (ACS) cases. Further studies are needed to define safe IAP levels for repairing large abdominal defects.
Area of Science:
- Abdominal Surgery
- Critical Care Medicine
- Surgical Physiology
Background:
- Laparostomy is a common surgical procedure for conditions like obstruction, peritonitis, or trauma to prevent abdominal compartment syndrome (ACS).
- Failure to achieve fascial closure after laparostomy often results in incisional hernias (up to 90% of cases).
- Intra-abdominal pressure (IAP) has not been previously assessed as a factor for determining the feasibility of fascial closure.
Purpose of the Study:
- To evaluate the impact of fascial closure on intra-abdominal pressure (IAP) following laparostomy.
- To assess the safety and physiological consequences of increased IAP after abdominal wall closure.
- To compare IAP levels post-fascial closure with those in patients undergoing elective abdominal surgery.
Main Methods:
- Forty patients underwent laparostomy over 12 months, with 23 having definitive abdominal closure.
- Intravesical pressure was used to measure IAP before and after fascial closure.
- Cardiocirculatory, renal, pulmonary, and liver function parameters were monitored and compared to 90 patients undergoing elective surgery.
Main Results:
- Fascial closure significantly increased IAP from 6.5+/-3.3 to 12.0+/-4.1 mmHg.
- Postoperative urine output decreased by 27% initially but normalized later; central venous pressure increased by 31%.
- No instances of abdominal compartment syndrome (ACS) were observed, and other organ functions remained stable. IAP in elective surgery patients ranged from 6.5 to 10.0 mmHg.
Conclusions:
- Fascial closure following laparostomy leads to a transient increase in IAP and a short-term reduction in urine output.
- The observed IAP levels after fascial closure appear safe, without causing ACS.
- Further research is necessary to establish critical IAP thresholds for safe repair of extensive fascial defects.