The role of open abdomen in non-trauma patient: WSES Consensus Paper
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The role of open abdomen in non-trauma patient: WSES Consensus Paper Federico Coccolini1*, Giulia Montori1, Marco Ceresoli1, Fausto Catena2, Ernest E. Moore3, Rao Ivatury4, Walter Biffl5, Andrew Peitzman6, Raul Coimbra7, Sandro Rizoli8, Yoram Kluger9, Fikri M. Abu-Zidan10, Massimo Sartelli11, Marc De Moya12, George Velmahos12, Gustavo Pereira Fraga13, Bruno M. Pereira13, Ari Leppaniemi14, Marja A. Boermeester15, Andrew W. Kirkpatrick16, Ron Maier17, Miklosh Bala18, Boris Sakakushev19, Vladimir Khokha20, Manu Malbrain21, Vanni Agnoletti22, Ignacio Martin-Loeches23, Michael Sugrue24, Salomone Di Saverio25, Ewen Griffiths26, Kjetil Soreide27,28, John E. Mazuski29, Addison K. May30, Philippe Montravers31, Rita Maria Melotti32, Michele Pisano1, Francesco Salvetti1, Gianmariano Marchesi33, Tino M. Valetti33, Thomas Scalea34, Osvaldo Chiara35, Jeffry L. Kashuk36 and Luca Ansaloni1
Abstract The open abdomen (OA) is defined as intentional decision to leave the fascial edges of the abdomen un-approximated after laparotomy (laparostomy). The abdominal contents are potentially exposed and therefore must be protected with a temporary coverage, which is referred to as temporal abdominal closure (TAC). OA use remains widely debated with many specific details deserving detailed assessment and clarification. To date, in patients with intra-abdominal emergencies, the OA has not been formally endorsed for routine utilization; although, utilization is seemingly increasing. Therefore, the World Society of Emergency Surgery (WSES), Abdominal Compartment Society (WSACS) and the Donegal Research Academy united a worldwide group of experts in an international consensus conference to review and thereafter propose the basis for evidence-directed utilization of OA management in non-trauma emergency surgery and critically ill patients. In addition to utilization recommendations, questions with insufficient evidence urgently requiring future study were identified. Keywords: Open abdomen, Laparostomy, Non-trauma, Peritonitis, Pancreatitis, Vascular emergencies, Fistula, Nutrition, Re-exploration, Re-intervention, Closure, Biological, Synthetic, Mesh, Technique, Timing
Background The decision by a surgeon to utilize the open abdomen (OA) technique is a dramatically non-anatomic situation that dramatically increases resource utilization and has potential severe side effects. It is, however, often dramatically effective at countering the drastically impaired physiology of critical illness when no other perceived options exist. There are both mandatory and relative indications for OA use, which are heavily influenced by the primary pathophysiologic insults and responses to intra-abdominal sepsis and inflammation, both inherent to the patient and induced through medical treatments. * Correspondence: [email protected] 1 General, Emergency and Trauma Surgery dept., Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy Full list of author information is available at the end of the article
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