The management of the open abdomen in trauma and emergency general surgery: Part 1-damage control

Jose J. Diaz, Daniel C. Cullinane, William D. Dutton, Rebecca Jerome, Richard Bagdonas, Jarolslaw O. Bilaniuk, Bryan R. Collier, John J. Como, John Cumming, Maggie Griffen, Oliver L. Gunter, John Kirby, Larry Lottenburg, Nathan Mowery, William P. Riordan, Niels Martin, Jon Platz, Nicole Stassen, Eleanor S. Winston

Research output: Contribution to journalReview articlepeer-review

127 Scopus citations

Abstract

Background: The open abdomen technique, after both military and civilian trauma, emergency general or vascular surgery, has been used in some form for the past 30 years. There have been several hundred citations on the indications and the management of the open abdomen. Eastern Association for the Surgery of Trauma practice management committee convened a study group to organize the world's literature for the management of the open abdomen. This effort was divided into two parts: damage control and the management of the open abdomen. Only damage control is presented in this study. Part 1 is divided into indications for the open abdomen, temporary abdominal closure, staged abdominal repair, and nutrition support of the open abdomen. Methods: A literature review was performed for more than 30 years. Prospective and retrospective studies were included. The reviews and case reports were excluded. Of 1,200 articles, 95 were selected. Seventeen surgeons reviewed the articles with four defined criteria. The Eastern Association for the Surgery of Trauma primer was used to grade the evidence. Results: There was only one level I recommendation. A patient with documented abdominal compartment syndrome should undergo decompressive laparotomy. Conclusion: The open abdomen technique remains a heroic maneuver in the care of the critically ill trauma or surgical patient. For the best outcomes, a protocol for the indications, temporary abdominal closure, staged abdominal reconstruction, and nutrition support should be in place.

Original languageEnglish
Pages (from-to)1425-1437
Number of pages13
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume68
Issue number6
DOIs
StatePublished - Jun 1 2010

Keywords

  • Acute pancreatitis
  • Damage control
  • Emergency general surgery
  • Emergency vascular surgery
  • Intraabdominal sepsis
  • Nutrition in trauma
  • Open abdomen
  • Staged abdominal reconstruction (STAR)
  • Temporary abdominal closure
  • Trauma

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