Temporary Abdominal Closure Techniques

Excerpt

After a laparotomy, primary closure of the abdominal fascia is typically the preferred approach. However, situations may arise where complete fascial closure becomes unattainable, necessitating the surgeon to leave the abdomen open. This open abdomen poses a significant challenge and is associated with mortality rates exceeding 30%. Common scenarios leading to an open abdomen include peritonitis-induced bowel edema, abdominal compartment syndrome, and damage control surgery for trauma patients with intraabdominal bleeding. Temporary abdominal closure (TAC) techniques become imperative in such cases, aiming to provide a provisional solution until the abdominal fascia can be closed. Various TAC techniques are employed to address the challenges posed by the open abdomen. These techniques include negative pressure wound therapy, dynamic retention sutures, plastic silo (Bogotá bag), mesh/sheet, loose packing, skin approximation, and zipper. Each technique offers distinct advantages in maintaining tension on the fascial edges while accommodating varying clinical scenarios. Understanding and mastering these TAC techniques are critical for clinicians managing patients with an open abdomen, as failure to achieve delayed primary fascial closure puts patients at risk of developing ventral hernias with associated burdens and potential surgical complications. While the strategy for TAC or permanent abdominal closure should consider individual patient factors and risks, evidence-based comparative trials are lacking, highlighting the need for further research in this domain. The subsequent article explores TAC techniques' intricacies, mechanisms, applications, and potential complications.