The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper.
Massimo Sartelli ; Fikri M. Abu-Zidan ; Ernest E. Moore ; Maria Paula Garcia ; Martin D. Zielinski ; Sanoop K. Zachariah ; Jan Ulrych ; Vishal G. Shelat ; Haralds Plaudis ; Gerson Alves Pereira ; Carlos A. Ordonez ; Frederick A. Moore ; Sanjay Marwah ; Michael McFarlane ; Jae Gil Lee ; Ari Leppaniemi ; Rifat Latifi ; Yoram Kluger ; Reinhold Kafka-Ritsch ; Victor Y. Kong ; Aleksandar Karamarkovic ; Andreas Hecker ; Sanjay Gupta ; Ewen A. Griffiths ; Wagih Ghnnam ; Gustavo P. Fraga ; Salomone Di Saverio ; Jose J. Diaz ; Demetrios Demetriades ; Zaza Demetrashvili ; Raul Coimbra ; Federico Coccolini ; Osvaldo Chiara ; Fausto Catena ; Walter L. Biffl ; Marcelo A. Beltrán ; Miklosh Bala ; Luca Ansaloni
World Journal of Emergency Surgery, Vol.10(35) : 1~11, 2015
World Journal of Emergency Surgery
The open abdomen (OA) procedure is a significant surgical advance, as part of damage control techniques in severe abdominal trauma. Its application can be adapted to the advantage of patients with severe abdominal sepsis, however its precise role in these patients is still not clear. In severe abdominal sepsis the OA may allow early identification and draining of any residual infection, control any persistent source of infection, and remove more effectively infected or cytokine-loaded peritoneal fluid, preventing abdominal compartment syndrome and deferring definitive intervention and anastomosis until the patient is appropriately resuscitated and hemodynamically stable and thus better able to heal. However, the OA may require multiple returns to the operating room and may be associated with significant complications, including enteroatmospheric fistulas, loss of abdominal wall domain and large hernias. Surgeons should be aware of the pathophysiology of severe intra-abdominal sepsis and always keep in mind the option of using open abdomen to be able to use it in the right patient at the right time.