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The open abdomen in trauma and non-trauma patients: WSES guidelines

2018; BioMed Central; Volume: 13; Issue: 1 Linguagem: Inglês

10.1186/s13017-018-0167-4

1749-7922

Federico Coccolini, Derek J. Roberts, Luca Ansaloni, Rao R. Ivatury, Emiliano Gamberini, Yoram Kluger, Ernest E. Moore, Raúl Coimbra, Andrew W. Kirkpatrick, Bruno M. Pereira, Giulia Montori, Marco Ceresoli, Fikri M. Abu‐Zidan, Massimo Sartelli, George C. Velmahos, Gustavo Pereira Fraga, Ari Leppäniemi, Matti Tolonen, Joseph M. Galante, Tarek Razek, Ron Maier, Miklosh Bala, Boris Sakakushev, Vladimir Khokha, Manu L. N. G. Malbrain, Vanni Agnoletti, Andrew B. Peitzman, Zaza Demetrashvili, Michael Sugrue, Salomone Di Saverio, Ingo Martzi, Kjetil Søreide, Walter Biffl, Paula Ferrada, Neil Parry, Philippe Montravers, Rita Maria Melotti, Francesco Salvetti, Tino Martino Valetti, Thomas M. Scalea, Osvaldo Chiara, Stefania Cimbanassi, Jeffry L. Kashuk, Martha Larrea, Juan Alberto Martínez Hernández, Heng-Fu Lin, Mircea Chirica, C. Arvieux, Camilla Bing, Tal M. Hörer, Belinda De Simone, Peter T. Masiakos, Viktor Reva, Nicola de’Angelis, Kaoru Kike, Zsolt J. Balogh, Paola Fugazzola, Matteo Tomasoni, Rifat Latifi, Noel Naidoo, Dieter Weber, Lauri Handolin, Kenji Inaba, Andreas Hecker, Yuan Kuo-Ching, Carlos A. Ordóñez, Sandro Rizoli, Carlos Augusto Gomes, Marc de Moya, Imtiaz Wani, Alain Chichom‐Mefire, Kenneth D Boffard, Lena M. Napolitano, Fausto Catena,

Hernia repair and management

Damage control resuscitation may lead to postoperative intra-abdominal hypertension or abdominal compartment syndrome. These conditions may result in a vicious, self-perpetuating cycle leading to severe physiologic derangements and multiorgan failure unless interrupted by abdominal (surgical or other) decompression. Further, in some clinical situations, the abdomen cannot be closed due to the visceral edema, the inability to control the compelling source of infection or the necessity to re-explore (as a "planned second-look" laparotomy) or complete previously initiated damage control procedures or in cases of abdominal wall disruption. The open abdomen in trauma and non-trauma patients has been proposed to be effective in preventing or treating deranged physiology in patients with severe injuries or critical illness when no other perceived options exist. Its use, however, remains controversial as it is resource consuming and represents a non-anatomic situation with the potential for severe adverse effects. Its use, therefore, should only be considered in patients who would most benefit from it. Abdominal fascia-to-fascia closure should be done as soon as the patient can physiologically tolerate it. All precautions to minimize complications should be implemented.