Open abdomen techniques - a herniologist's view

Open abdomen, laparostomy, or temporary abdominal closure, represent a surgical strategy in which the abdominal cavity is intentionally left unclosed after laparotomy. This approach is indicated primarily in critically ill patients in whom primary abdominal wall closure would result in deterioration of intra-abdominal conditions or prevent adequate control of the underlying pathology. This group mainly includes patients with generalized peritonitis, severe acute pancreatitis, major abdominal trauma, or significant visceral edema. A second group comprises patients undergoing decompressive laparotomy for abdominal compartment syndrome, in whom primary abdominal wall closure is not technically feasible. Management of patients with open abdomen includes appropriate patient selection, correct timing of decompressive laparotomy, choice of an optimal temporary abdominal closure technique, and an ongoing effort to achieve early definitive abdominal wall closure. Techniques of temporary abdominal closure have undergone substantial development over the past two decades. Static methods of temporary abdominal closure, including simple coverage of the abdominal cavity using negative pressure wound therapy, are currently being progressively replaced by dynamic techniques. These modern approaches combine non-adherent protective coverage of the visceral organs, active approximation of the abdominal wall edges through continuous or intermittent traction, and the simultaneous application of negative pressure. This topic is regularly addressed in a dedicated session at the annual congress of the European Hernia Society, and a European Open Abdomen Registry (EHS Open Abdomen Registry) has been established, currently including more than 1,000 reported cases. Involvement of a surgeon specialized in elective abdominal wall reconstruction is crucial for optimizing long-term outcomes and highlights the close integration of emergency abdominal surgery and abdominal wall surgery.