Stepwise plication of abdominal mesh technique for open abdomen closure

To present the stepwise plication of abdominal mesh (SPAM) as a standardized dynamic closure technique that combines mesh-mediated fascial traction with negative pressure wound therapy for gradual abdominal wall approximation.

In this technical report, we present SPAM for progressive closure of peritoneostomy with excessive abdominal wall retraction. It involves a central mesh incision followed by progressive tightening via hemostatic clamp rotation (similar to opening a can with a key), without full-thickness mesh cut. The mesh is secured with continuous suture and covered with a non-commercial negative pressure system. Cycles are repeated every 48-72 hours until fascial closure.

SPAM was applied in four patients: three successful cases (52-year-old male with rectal perforation, 36-year-old female post-Hartmann evisceration, 63-year-old female with gastrojejunal anastomosis leak) achieved primary fascial closure in a median of 10 days, with well-tolerated traction, no enteroatmospheric fistula, or incisional hernia. In one failure (59-year-old male with gastrojejunal leak post-laparoscopic gastrectomy), bleeding occurred during traction (controlled surgically), yet the technique was discontinued due to progressive clinical deterioration.

SPAM offers a practical, standardized, reproducible approach to delayed fascial closure, particularly in resource-limited settings, enabling controlled progressive approximation without mesh resection.