TY - JOUR
T1 - International consensus conference on open abdomen in trauma
AU - Chiara, Osvaldo
AU - Cimbanassi, Stefania
AU - Biffl, Walter
AU - Leppaniemi, Ari
AU - Henry, Sharon
AU - Scalea, Thomas M.
AU - Catena, Fausto
AU - Ansaloni, Luca
AU - Chieregato, Arturo
AU - de Blasio, Elvio
AU - Gambale, Giorgio
AU - Gordini, Giovanni
AU - Nardi, Guiseppe
AU - Paldalino, Pietro
AU - Gossetti, Francesco
AU - Dionigi, Paolo
AU - Noschese, Giuseppe
AU - Tugnoli, Gregorio
AU - Ribaldi, Sergio
AU - Sgardello, Sebastian
AU - Magnone, Stefano
AU - Rausei, Stefano
AU - Mariani, Anna
AU - Mengoli, Francesca
AU - di Saverio, Salomone
AU - Castriconi, Maurizio
AU - Coccolini, Federico
AU - Negreanu, Joseph
AU - Razzi, Salvatore
AU - Coniglio, Carlo
AU - Morelli, Francesco
AU - Buonanno, Maurizio
AU - Lippi, Monica
AU - Trotta, Liliana
AU - Volpi, Annalisa
AU - Fattori, Luca
AU - Zago, Mauro
AU - de Rai, Paolo
AU - Sammartano, Fabrizio
AU - Manfredi, Roberto
AU - Cingolani, Emiliano
PY - 2016/1/1
Y1 - 2016/1/1
N2 - BACKGROUND: A part of damage-control laparotomy is to leave the fascial edges and the skin open to avoid abdominal compartment syndrome and allow further explorations. This condition, known as open abdomen (OA), although effective, is associated with severe complications. Our aim was to develop evidence-based recommendations to define indications for OA, techniques for temporary abdominal closure, management of enteric fistulas, and methods of definitive wall closure.METHODS: The literature from 1990 to 2014 was systematically screened according to PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-analyses] protocol. Seventy-six articles were reviewed by a panel of experts to assign grade of recommendations (GoR) and level of evidence (LoE) using the GRADE [Grading of Recommendations Assessment, Development, and Evaluation] system, and an international consensus conference was held.RESULTS: OA in trauma is indicated at the end of damage-control laparotomy, in the presence of visceral swelling, for a second look in vascular injuries or gross contamination, in the case of abdominal wall loss, and if medical treatment of abdominal compartment syndrome has failed (GoR B, LoE II). Negative-pressure wound therapy is the recommended temporary abdominal closure technique to drain peritoneal fluid, improve nursing, and prevent fascial retraction (GoR B, LoE I). Lack of OA closure within 8 days (GoR C, LoE II), bowel injuries, high-volume replacement, and use of polypropylene mesh over the bowel (GoR C, LoE I) are risk factors for frozen abdomen and fistula formation. Negative-pressure wound therapy allows to isolate the fistula and protect the surrounding tissues from spillage until granulation (GoR C, LoE II). Correction of fistula is performed after 6 months to 12 months. Definitive closure of OA has to be obtained early (GoR C, LoE I) with direct suture, traction devices, component separation with or without mesh. Biologic meshes are an option for wall reinforcement if bacterial contamination is present (GoR C, LoE II).CONCLUSION: OA and negative-pressure techniques improve the care of trauma patients, but closure must be achieved early to avoid complications.
AB - BACKGROUND: A part of damage-control laparotomy is to leave the fascial edges and the skin open to avoid abdominal compartment syndrome and allow further explorations. This condition, known as open abdomen (OA), although effective, is associated with severe complications. Our aim was to develop evidence-based recommendations to define indications for OA, techniques for temporary abdominal closure, management of enteric fistulas, and methods of definitive wall closure.METHODS: The literature from 1990 to 2014 was systematically screened according to PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-analyses] protocol. Seventy-six articles were reviewed by a panel of experts to assign grade of recommendations (GoR) and level of evidence (LoE) using the GRADE [Grading of Recommendations Assessment, Development, and Evaluation] system, and an international consensus conference was held.RESULTS: OA in trauma is indicated at the end of damage-control laparotomy, in the presence of visceral swelling, for a second look in vascular injuries or gross contamination, in the case of abdominal wall loss, and if medical treatment of abdominal compartment syndrome has failed (GoR B, LoE II). Negative-pressure wound therapy is the recommended temporary abdominal closure technique to drain peritoneal fluid, improve nursing, and prevent fascial retraction (GoR B, LoE I). Lack of OA closure within 8 days (GoR C, LoE II), bowel injuries, high-volume replacement, and use of polypropylene mesh over the bowel (GoR C, LoE I) are risk factors for frozen abdomen and fistula formation. Negative-pressure wound therapy allows to isolate the fistula and protect the surrounding tissues from spillage until granulation (GoR C, LoE II). Correction of fistula is performed after 6 months to 12 months. Definitive closure of OA has to be obtained early (GoR C, LoE I) with direct suture, traction devices, component separation with or without mesh. Biologic meshes are an option for wall reinforcement if bacterial contamination is present (GoR C, LoE II).CONCLUSION: OA and negative-pressure techniques improve the care of trauma patients, but closure must be achieved early to avoid complications.
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U2 - 10.1097/TA.0000000000000882
DO - 10.1097/TA.0000000000000882
M3 - Article
C2 - 27551925
AN - SCOPUS:84983530452
VL - 80
SP - 173
EP - 183
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
SN - 2163-0755
IS - 1
ER -