Managing the open abdomen

Control of intra-abdominal fluid secretion, facilitation of abdominal exploration, and preservation of the fascia for abdominal wall closure is a major challenge in the management of patients with an open abdomen. Studies comparing different protocols of care have not been conducted and frequency of exploration, surgical procedures, and indications for definitive closure are generally based on clinical judgment. Morbidity and mortality rates are high. Vacuum-assisted therapy has been reported to help meet the challenges of managing the open abdomen and is particularly useful in patients with abdominal compartment syndromes, traumatic injuries, and severe intra-abdominal sepsis. Over the years, clinicians have developed various approaches to achieve vacuum-assisted closure using wall suction. Some disadvantages of the wall-suction methods are eliminated when using more recently developed vacuum therapy devices. These devices apply subatmospheric pressure, reducing bowel edema, bacterial counts, and inflammatory substances found in open abdominal wounds while eliminating the need for frequent dressing changes, maintaining intact skin, and improving fluid management. The results of six case studies presented are encouraging, suggesting that this treatment approach is safe and effective. Controlled clinical studies to establish the safety and effectiveness of this treatment approach and to facilitate the development of treatment guidelines are needed to help manage an increasingly common group of patients who might benefit from this treatment approach.