The open abdomen, indications, management and definitive closure

Area of Science:

• Surgical critical care
• Abdominal surgery
• Trauma surgery

Background:

• Intra-abdominal hypertension (IAH) and abdominal compartmental syndrome (ACS) are critical complications in surgical patients.
• Proactive management to prevent IAH and ACS is essential for critically ill patients.
• Open Abdomen (OA) is a strategy employed when IAH/ACS is developing or present.

Purpose of the Study:

• To review the indications and management strategies for Open Abdomen (OA).
• To highlight the importance of preventing IAH and ACS.
• To discuss advancements in OA closure techniques and their impact on patient outcomes.

Main Methods:

• Review of current literature and guidelines on Open Abdomen (OA) management.
• Discussion of therapeutic goals, including early opening and closure.
• Emphasis on innovative closure strategies like negative pressure wound therapy and dynamic closure.

Main Results:

• Open Abdomen (OA) is indicated for conditions leading to intra-abdominal hypertension (IAH).
• Goal-directed therapy for ACS involves early opening and closure.
• Advanced closure methods, including negative pressure wound therapy, aim to minimize complications such as incisional hernias.

Conclusions:

• While survival has improved, Open Abdomen (OA) remains a morbid procedure.
• Continued research and innovation are necessary to refine OA indications and optimize treatment.
• A shift in closure paradigms, incorporating advanced therapies, is key to reducing OA-related morbidity.