Staged abdominal repair in critical illness

Area of Science:

• Surgical innovation
• Critical care medicine
• Abdominal surgery

Background:

• High intra-abdominal pressure (IAP) complicates abdominal closure in critically ill patients.
• Staged abdominal repair is often necessary for abdominal compartment syndrome and complex abdominal wall defects.
• The Marlex mesh interposition as part of staged abdominal repair (M-STAR) technique was developed to address these challenges.

Purpose of the Study:

• To evaluate the impact of M-STAR on physiological parameters in critically ill patients.
• To assess the safety and efficacy of M-STAR in facilitating abdominal closure and repeat laparotomies.
• To determine the short- and long-term surgical sequelae associated with M-STAR.

Main Methods:

• Retrospective analysis of 66 critical care admissions undergoing M-STAR (68 occasions).
• Indications included pressure reduction during closure (46), facilitating multiple laparotomies (15), or defect repair (3).
• Physiological data (compliance, oxygenation, ventilation, hemodynamics, urine output) were analyzed before and after M-STAR in ventilated patients.

Main Results:

• M-STAR significantly improved respiratory compliance (Vt/[Paw-PEEP] 22.6 to 30.3 ml/cm H2O, P < 0.0001).
• Heart rate decreased (130 to 110 bpm, P = 0.01) and urine flow increased (60 to 110 ml/h, P = 0.007).
• Oxygenation and ventilation efficiency were unchanged; blood pressure and inotrope requirements remained stable. Seven bowel fistulae and three dehiscences were noted.

Conclusions:

• M-STAR effectively reduces intra-abdominal pressure and improves respiratory compliance in critically ill patients.
• The technique facilitates staged abdominal repair and repeat laparotomies with acceptable short- and long-term surgical outcomes.
• M-STAR is a valuable adjunct in managing complex abdominal conditions in the intensive care setting.