International consensus conference on open abdomen in trauma

Area of Science:

• Trauma Surgery
• Surgical Critical Care
• Abdominal Wall Reconstruction

Background:

• Open abdomen (OA) is a strategy used in damage-control laparotomy to manage increased intra-abdominal pressure and facilitate further surgical exploration.
• While effective, OA is associated with significant complications, including abdominal compartment syndrome, entero-cutaneous fistulas, and incisional hernia formation.
• Developing evidence-based recommendations for OA indications, temporary closure, fistula management, and definitive closure is essential for improving patient outcomes.

Framework:

• Systematic literature review from 1990-2014 following PRISMA guidelines.
• Expert panel review and application of GRADE system for grading of recommendations (GoR) and level of evidence (LoE).
• International consensus conference to establish evidence-based recommendations.

Implementation:

• Negative-pressure wound therapy (NPWT) is the recommended technique for temporary abdominal closure (GoR B, LoE I).
• Indications for OA include visceral swelling, vascular injury re-exploration, gross contamination, abdominal wall loss, and failed non-operative management of abdominal compartment syndrome (GoR B, LoE II).
• Risk factors for complications like frozen abdomen and fistula formation include delayed OA closure (>8 days), bowel injuries, and mesh use over the bowel (GoR C, LoE I).

Implications:

• Early definitive closure of the open abdomen is critical to minimize complications (GoR C, LoE I).
• NPWT aids in managing enteric fistulas by isolating them and protecting surrounding tissues until definitive repair, typically 6-12 months post-injury (GoR C, LoE II).
• Definitive closure techniques include direct suture, traction devices, and component separation, with biologic meshes as an option for contaminated fields (GoR C, LoE II).