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

Federico Coccolini, Derek Roberts, Luca Ansaloni, Rao Ivatury, Emiliano Gamberini, Yoram Kluger, Ernest E Moore, Raul Coimbra, Andrew W Kirkpatrick, Bruno M Pereira, Giulia Montori, Marco Ceresoli, Fikri M Abu-Zidan, Massimo Sartelli, George Velmahos, Gustavo Pereira Fraga, Ari Leppaniemi, Matti Tolonen, Joseph Galante, Tarek Razek, Ron Maier, Miklosh Bala, Boris Sakakushev, Vladimir Khokha, Manu Malbrain, Vanni Agnoletti, Andrew Peitzman, Zaza Demetrashvili, Michael Sugrue, Salomone Di Saverio, Ingo Martzi, Kjetil Soreide, Walter Biffl, Paula Ferrada, Neil Parry, Philippe Montravers, Rita Maria Melotti, Francesco Salvetti, Tino M Valetti, Thomas Scalea, Osvaldo Chiara, Stefania Cimbanassi, Jeffry L Kashuk, Martha Larrea, Juan Alberto Martinez Hernandez, Heng-Fu Lin, Mircea Chirica, Catherine Arvieux, Camilla Bing, Tal Horer, Belinda De Simone, Peter Masiakos, Viktor Reva, Nicola DeAngelis, 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 Ordoñez, Sandro Rizoli, Carlos Augusto Gomes, Marc De Moya, Imtiaz Wani, Alain Chichom Mefire, Ken Boffard, Lena Napolitano, Fausto Catena

Journal: World journal of emergency surgery : WJES 2018;13():7

PMID: 29434652

Abstract

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.

Address: 1General Emergency and Trauma Surgery, Bufalini Hospital, Viale Giovanni Ghirotti, 286, 47521 Cesena, Italy.; 2Department of Surgery, Foothills Medical Centre, Calgary, Canada.; 3Virginia Commonwealth University, Richmond, VA USA.; 4ICU Department, Bufalini Hospital, Cesena, Italy.; 5Division of General Surgery, Rambam Health Care Campus, Haifa, Israel.; 6Trauma Surgery, Denver Health, Denver, CO USA.; 7Department of Surgery, UC San Diego Health System, San Diego, USA.; 8Faculdade de Ciências Médicas (FCM)-Unicamp Campinas, Campinas, SP Brazil.; 9Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.; Department of Surgery, Macerata Hospital, Macerata, Italy.; 11Department of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA USA.; Second Department of Surgery, Meilahti Hospital, Helsinki, Finland.; 13Trauma and Acute Care Surgery and Surgical Critical Care Trauma, Department of Surgery, University of California, Davis, USA.; 14General and Emergency Surgery, McGill University Health Centre, Montréal, QC Canada.; Department of Surgery, Harborview Medical Centre, Seattle, USA.; 16General Surgery Department, Hadassah Medical Centre, Jerusalem, Israel.; First Clinic of General Surgery, University Hospital/UMBAL/St George Plovdiv, Plovdiv, Bulgaria.; General Surgery, Mozir Hospital, Mozir City, Belarus.; ICU and High Care Burn Unit, Ziekenhius Netwerk Antwerpen, Antwerpen, Belgium.; 20Department of Surgery, Trauma and Surgical Services, University of Pittsburgh School of Medicine, Pittsburgh, USA.; Department of Surgery, Tbilisi State Medical University, Kipshidze Central University Hospital, Tbilisi, Georgia.; General Surgery Department, Letterkenny Hospital, Letterkenny, Ireland.; 23Addenbrooke's Hospital, Cambridge, UK.; 24Klinik für Unfall-, Hand- und Wiederherstellungschirurgie Universitätsklinikum Goethe-Universität Frankfurt, Frankfurt, Germany.; 25Department of Clinical Medicine, University of Bergen, Bergen, Norway.; 26Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.; 27Acute Care Surgery, The Queen's Medical Center, Honolulu, HI USA.; 28General and Trauma Surgery Department, London Health Sciences Centre, Victoria Hospital, London, ON Canada.; 29Département d'Anesthésie-Réanimation, CHU Bichat Claude-Bernard-HUPNVS, Assistance Publique-Hôpitaux de Paris, University Denis Diderot, Paris, France.; 30ICU Department, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.; 31ICU Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.; 32Surgery Department, University of Maryland School of Medicine, Baltimore, MD USA.; 33Emergency and Trauma Surgery Department, Niguarda Hospital, Milano, Italy.; 34General Surgery Department, Assuta Medical Centers, Tel Aviv, Israel.; General Surgery, "General Calixto García", Habana Medicine University, Havana, Cuba.; General Surgery, Medical Faculty "General Calixto Garcia", Habana Medicine University, Havana, Cuba.; Division of Trauma, Department of Surgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan, Republic of China.; 38Clin. Univ. de Chirurgie Digestive et de l'Urgence, CHUGA-CHU Grenoble Alpes UGA-Université Grenoble Alpes, Grenoble, France.; General and Emergency Surgery Department, Empoli Hospital, Empoli, Italy.; 40Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital and Örebro University, Orebro, Sweden.; General Surgery, Perpignan Hospital, Perpignan, France.; 42Pediatric Trauma Service, Massachusetts General Hospital, Boston, MA USA.; General and Emergency Surgery, Sergei Kirov Military Academy, Saint Petersburg, Russia.; 44Unit of Digestive Surgery, HPB Surgery and Liver Transplant, Henri Mondor Hospital, Créteil, France.; 45Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.; 46Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia.; 47General Surgery Department, Westchester Medical Center, Westchester, NY USA.; 48Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.; 49Department of General Surgery, Royal Perth Hospital, The University of Western Australia & The University of Newcastle, Perth, Australia.; 50Trauma Unit, Helsinki University Hospital, Helsinki, Finland.; 51Division of Trauma and Critical Care, LAC+USC Medical Center, University of Southern California, California, Los Angeles USA.; General and Thoracic Surgery, Giessen Hospital, Giessen, Germany.; 53Acute Care Surgery and Traumatology, Taipei Medical University Hospital, Taipei City, Taiwan, Republic of China.; 54Trauma and Acute Care Surgery, Fundacion Valle del Lili, Cali, Colombia.; 55Trauma and Acute Care Service, St Michael's Hospital, Toronto, ON Canada.; Hospital Universitário Terezinha de Jesus, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, Brazil.; Trauma, Acute Care Surgery, Medical College of Wisconsin/Froedtert Trauma Center, Milwaukee, WI USA.; 58Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India.; 59Department of Surgery and Obs/Gyn, Faculty of Health Sciences, University of Buea, Buea, Cameroon.; 60Milpark Hospital Academic Trauma Center, University of the Witwatersrand, Johannesburg, South Africa.; 61Acute Care Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI USA.; Emergency and Trauma Surgery, Parma Maggiore Hospital, Parma, Italy.
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