International consensus conference on open abdomen in trauma

Osvaldo Chiara, Stefania Cimbanassi, Walter Biffl, Ari Leppaniemi, Sharon Henry, Thomas M. Scalea, Fausto Catena, Luca Ansaloni, Arturo Chieregato, Elvio de Blasio, Giorgio Gambale, Giovanni Gordini, Guiseppe Nardi, Pietro Paldalino, Francesco Gossetti, Paolo Dionigi, Giuseppe Noschese, Gregorio Tugnoli, Sergio Ribaldi, Sebastian SgardelloStefano Magnone, Stefano Rausei, Anna Mariani, Francesca Mengoli, Salomone di Saverio, Maurizio Castriconi, Federico Coccolini, Joseph Negreanu, Salvatore Razzi, Carlo Coniglio, Francesco Morelli, Maurizio Buonanno, Monica Lippi, Liliana Trotta, Annalisa Volpi, Luca Fattori, Mauro Zago, Paolo de Rai, Fabrizio Sammartano, Roberto Manfredi, Emiliano Cingolani

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)173-183
Number of pages11
JournalJournal of Trauma and Acute Care Surgery
Volume80
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

ASJC Scopus subject areas

  • Medicine(all)

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