Amended Classification of the Open Abdomen

Area of Science:

• Surgical critical care
• Abdominal surgery
• Trauma surgery

Background:

• A classification system for the open abdomen was introduced in 2009 to standardize management and facilitate research.
• The system aimed to aid in describing clinical course, standardizing guidelines, and comparing studies.

Purpose of the Study:

• To revise the 2009 open abdomen classification system based on clinical experience and research.
• To address identified limitations in the previous classification, specifically regarding enteroatmospheric fistulae and grading severity.

Main Methods:

• The 2009 classification was reviewed and amended as part of updated consensus statements by the World Society of the Abdominal Compartment Syndrome.
• Nine cohort studies involving 542 patients classified under the 2009 system were reviewed.
• Key issues identified included the definition of enteroatmospheric fistulae and their severity grading relative to a frozen abdomen.

Main Results:

• An amended classification was proposed with four grades: Grade 1 (no adherence/fixity), Grade 2 (developing fixation), Grade 3 (frozen abdomen), and Grade 4 (enteroatmospheric fistula).
• Each grade is further subdivided based on contamination (clean, contaminated) and presence of enteric leak or fistula.
• Grade 4, enteroatmospheric fistula, is defined as a permanent enteric leak into the open abdomen with granulation tissue.

Conclusions:

• The revised classification aims to be functional and dynamic, meeting requirements for research and training.
• The authors encourage future investigators to utilize and report on the merits and constraints of the amended system.