BACKGROUND: Alternatives to fascial closure of the abdominal wall are increasingly used in critically ill patients. They pose practical and logistical problems in management which are described in this single-institution study. METHODS: Between January 1994 and December 1997, 157 predominantly young male patients (100 trauma and 57 non-trauma) underwent temporary abdominal content containment (t-ACC) using plastic bags or polyglactin mesh. Indications for t-ACC were severe sepsis requiring reoperation, abdominal compartment syndrome, abdominal wall tissue loss or a combination of these. A total of 385 laparotomies were performed. RESULTS: Two t-ACC procedures failed owing to technical error and two were complicated by enteric fistulas. Six patients underwent early definitive abdominal closure within 15 days. The remaining survivors had a protracted hospital stay (mean(s.d.) 44.6(26.6) days) and all developed incisional hernias which were challenging to repair. The overall mortality rate was 44 per cent. CONCLUSION: Plastic bags were cheaper and as effective as polyglactin mesh for t-ACC. Survivors require a multidisciplinary approach in management, undergo a protracted hospital stay and later need complex incisional hernia repairs.
BACKGROUND: Alternatives to fascial closure of the abdominal wall are increasingly used in critically illpatients. They pose practical and logistical problems in management which are described in this single-institution study. METHODS: Between January 1994 and December 1997, 157 predominantly young male patients (100 trauma and 57 non-trauma) underwent temporary abdominal content containment (t-ACC) using plastic bags or polyglactin mesh. Indications for t-ACC were severe sepsis requiring reoperation, abdominal compartment syndrome, abdominal wall tissue loss or a combination of these. A total of 385 laparotomies were performed. RESULTS: Two t-ACC procedures failed owing to technical error and two were complicated by enteric fistulas. Six patients underwent early definitive abdominal closure within 15 days. The remaining survivors had a protracted hospital stay (mean(s.d.) 44.6(26.6) days) and all developed incisional hernias which were challenging to repair. The overall mortality rate was 44 per cent. CONCLUSION: Plastic bags were cheaper and as effective as polyglactin mesh for t-ACC. Survivors require a multidisciplinary approach in management, undergo a protracted hospital stay and later need complex incisional hernia repairs.
Authors: Christian Hobeika; Marc-Antoine Allard; Petru-Octav Bucur; Salima Naili; Antonio Sa Cunha; Daniel Cherqui; Denis Castaing; René Adam; Eric Vibert Journal: World J Surg Date: 2017-12 Impact factor: 3.352
Authors: Manu L N G Malbrain; Michael L Cheatham; Andrew Kirkpatrick; Michael Sugrue; Michael Parr; Jan De Waele; Zsolt Balogh; Ari Leppäniemi; Claudia Olvera; Rao Ivatury; Scott D'Amours; Julia Wendon; Ken Hillman; Kenth Johansson; Karel Kolkman; Alexander Wilmer Journal: Intensive Care Med Date: 2006-09-12 Impact factor: 17.440