[Open abdomen. Evolution in management]

The open abdomen (OA) strategy is accepted in the treatment of extremely ill surgical patients. Its usage has increased in the last decade as the understanding of its functions, advantages and disadvantages increases. Unfortunately, it continues to be associated with very high morbidity and mortality, and the different techniques used to protect the intra-abdominal contents cannot be standardized for all surgical circumstances. The objective is to review the origins, actual indications and controversies of the staged abdominal repair (STAR) and to report on the latest and most used techniques to ensure an optimal temporary abdominal closure (TAC). A search was done in Medline and Ovid for articles with key words of open abdomen, temporary abdominal closure and staged abdominal repair. We found the use of the technique is justified in patients with trauma, abdominal compartment syndrome and patients with severe intra-abdominal sepsis. The technique used for TAC must always be individualized for each clinical circumstance. The best reported results have been obtained with the vacuum pack technique. In our own experience and as a general rule we discouraged the use of mesh to protect intra-abdominal contents. The strategy of OA is useful in complex surgical situations in extremely ill patients. Its use must be very carefully evaluated, knowing the potentially serious complications that the patient may develop with its use.