Sequential Fasciotomies for Managing Abdominal Compartment Syndrome: Porcine Experimental Study

Abdominal compartment syndrome (ACS) poses a significant clinical challenge, with high morbidity and mortality rates. Conventional treatment via decompressive laparotomy with open abdomen and temporary closure presents significant drawbacks. This experimental study evaluates the efficacy of open minimally invasive sequential fasciotomy in managing simulated ACS in a porcine model.

Ten adult pigs were included in this prospective experimental investigation, wherein a mechanical model of abdominal hypertension was induced by pneumoperitoneum via a Veres needle. Open minimally invasive sequential fasciotomy, involving bilateral external oblique muscles (EOMs) and linea alba (LA), was performed. Physiological parameters were recorded preprocedure and postprocedure.

In our study, 70% of pigs completed the fasciotomy sequence. Unilateral EOM fasciotomy significantly reduced intravesical pressure and femoral venous pressure by 18% and 16%, respectively. Bilateral EOM fasciotomies led to a 35.7% decrease in both parameters. Following re-establishment of intra-abdominal pressure to 20 mmHg, LA fasciotomy resulted in a 47% drop in intravesical pressure and femoral venous pressure. Significant increases in tidal volume and abdominal perimeter were observed after each fasciotomy.

This study establishes that open minimally invasive sequential fasciotomy of bilateral EOM and LA is an effective strategy for managing simulated ACS in a porcine model. Each fasciotomy resulted in a significant reduction in intra-abdominal pressure. These findings suggest that sequential fasciotomy techniques offer a promising alternative to decompressive laparotomy in ACS management. Further research is essential to validate these outcomes in human subjects.