The open abdomen in trauma and non-trauma patients: WSES guidelines

doi:10.1186/s13017-018-0167-4

Review

. 2018 Feb 2:13:7.

doi: 10.1186/s13017-018-0167-4. eCollection 2018.

The open abdomen in trauma and non-trauma patients: WSES guidelines

Federico Coccolini¹, Derek Roberts², Luca Ansaloni¹, Rao Ivatury³, Emiliano Gamberini⁴, Yoram Kluger⁵, Ernest E Moore⁶, Raul Coimbra⁷, Andrew W Kirkpatrick², Bruno M Pereira⁸, Giulia Montori¹, Marco Ceresoli¹, Fikri M Abu-Zidan⁹, Massimo Sartelli¹⁰, George Velmahos¹¹, Gustavo Pereira Fraga⁸, Ari Leppaniemi¹², Matti Tolonen¹², Joseph Galante¹³, Tarek Razek¹⁴, Ron Maier¹⁵, Miklosh Bala¹⁶, Boris Sakakushev¹⁷, Vladimir Khokha¹⁸, Manu Malbrain¹⁹, Vanni Agnoletti⁴, Andrew Peitzman²⁰, Zaza Demetrashvili²¹, Michael Sugrue²², Salomone Di Saverio²³, Ingo Martzi²⁴, Kjetil Soreide^{25

26}, Walter Biffl²⁷, Paula Ferrada³, Neil Parry²⁸, Philippe Montravers²⁹, Rita Maria Melotti³⁰, Francesco Salvetti¹, Tino M Valetti³¹, Thomas Scalea³², Osvaldo Chiara³³, Stefania Cimbanassi³³, Jeffry L Kashuk³⁴, Martha Larrea³⁵, Juan Alberto Martinez Hernandez³⁶, Heng-Fu Lin³⁷, Mircea Chirica³⁸, Catherine Arvieux³⁸, Camilla Bing³⁹, Tal Horer⁴⁰, Belinda De Simone⁴¹, Peter Masiakos⁴², Viktor Reva⁴³, Nicola DeAngelis⁴⁴, Kaoru Kike⁴⁵, Zsolt J Balogh⁴⁶, Paola Fugazzola¹, Matteo Tomasoni¹, Rifat Latifi⁴⁷, Noel Naidoo⁴⁸, Dieter Weber⁴⁹, Lauri Handolin⁵⁰, Kenji Inaba⁵¹, Andreas Hecker⁵², Yuan Kuo-Ching⁵³, Carlos A Ordoñez⁵⁴, Sandro Rizoli⁵⁵, Carlos Augusto Gomes⁵⁶, Marc De Moya⁵⁷, Imtiaz Wani⁵⁸, Alain Chichom Mefire⁵⁹, Ken Boffard⁶⁰, Lena Napolitano⁶¹, Fausto Catena⁶²

Affiliations

¹ 1General Emergency and Trauma Surgery, Bufalini Hospital, Viale Giovanni Ghirotti, 286, 47521 Cesena, Italy.
² 2Department of Surgery, Foothills Medical Centre, Calgary, Canada.
³ 3Virginia Commonwealth University, Richmond, VA USA.
⁴ 4ICU Department, Bufalini Hospital, Cesena, Italy.
⁵ 5Division of General Surgery, Rambam Health Care Campus, Haifa, Israel.
⁶ 6Trauma Surgery, Denver Health, Denver, CO USA.
⁷ 7Department of Surgery, UC San Diego Health System, San Diego, USA.
⁸ 8Faculdade de Ciências Médicas (FCM)-Unicamp Campinas, Campinas, SP Brazil.
⁹ 9Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
¹⁰ Department of Surgery, Macerata Hospital, Macerata, Italy.
¹¹ 11Department of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA USA.
¹² Second Department of Surgery, Meilahti Hospital, Helsinki, Finland.
¹³ 13Trauma and Acute Care Surgery and Surgical Critical Care Trauma, Department of Surgery, University of California, Davis, USA.
¹⁴ 14General and Emergency Surgery, McGill University Health Centre, Montréal, QC Canada.
¹⁵ Department of Surgery, Harborview Medical Centre, Seattle, USA.
¹⁶ 16General Surgery Department, Hadassah Medical Centre, Jerusalem, Israel.
¹⁷ First Clinic of General Surgery, University Hospital/UMBAL/St George Plovdiv, Plovdiv, Bulgaria.
¹⁸ General Surgery, Mozir Hospital, Mozir City, Belarus.
¹⁹ ICU and High Care Burn Unit, Ziekenhius Netwerk Antwerpen, Antwerpen, Belgium.
²⁰ 20Department of Surgery, Trauma and Surgical Services, University of Pittsburgh School of Medicine, Pittsburgh, USA.
²¹ Department of Surgery, Tbilisi State Medical University, Kipshidze Central University Hospital, Tbilisi, Georgia.
²² General Surgery Department, Letterkenny Hospital, Letterkenny, Ireland.
²³ 23Addenbrooke's Hospital, Cambridge, UK.
²⁴ 24Klinik für Unfall-, Hand- und Wiederherstellungschirurgie Universitätsklinikum Goethe-Universität Frankfurt, Frankfurt, Germany.
²⁵ 25Department of Clinical Medicine, University of Bergen, Bergen, Norway.
²⁶ 26Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
²⁷ 27Acute Care Surgery, The Queen's Medical Center, Honolulu, HI USA.
²⁸ 28General and Trauma Surgery Department, London Health Sciences Centre, Victoria Hospital, London, ON Canada.
²⁹ 29Département d'Anesthésie-Réanimation, CHU Bichat Claude-Bernard-HUPNVS, Assistance Publique-Hôpitaux de Paris, University Denis Diderot, Paris, France.
³⁰ 30ICU Department, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
³¹ 31ICU Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.
³² 32Surgery Department, University of Maryland School of Medicine, Baltimore, MD USA.
³³ 33Emergency and Trauma Surgery Department, Niguarda Hospital, Milano, Italy.
³⁴ 34General Surgery Department, Assuta Medical Centers, Tel Aviv, Israel.
³⁵ General Surgery, "General Calixto García", Habana Medicine University, Havana, Cuba.
³⁶ General Surgery, Medical Faculty "General Calixto Garcia", Habana Medicine University, Havana, Cuba.
³⁷ Division of Trauma, Department of Surgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan, Republic of China.
³⁸ 38Clin. Univ. de Chirurgie Digestive et de l'Urgence, CHUGA-CHU Grenoble Alpes UGA-Université Grenoble Alpes, Grenoble, France.
³⁹ General and Emergency Surgery Department, Empoli Hospital, Empoli, Italy.
⁴⁰ 40Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital and Örebro University, Orebro, Sweden.
⁴¹ General Surgery, Perpignan Hospital, Perpignan, France.
⁴² 42Pediatric Trauma Service, Massachusetts General Hospital, Boston, MA USA.
⁴³ General and Emergency Surgery, Sergei Kirov Military Academy, Saint Petersburg, Russia.
⁴⁴ 44Unit of Digestive Surgery, HPB Surgery and Liver Transplant, Henri Mondor Hospital, Créteil, France.
⁴⁵ 45Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
⁴⁶ 46Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia.
⁴⁷ 47General Surgery Department, Westchester Medical Center, Westchester, NY USA.
⁴⁸ 48Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
⁴⁹ 49Department of General Surgery, Royal Perth Hospital, The University of Western Australia & The University of Newcastle, Perth, Australia.
⁵⁰ 50Trauma Unit, Helsinki University Hospital, Helsinki, Finland.
⁵¹ 51Division of Trauma and Critical Care, LAC+USC Medical Center, University of Southern California, California, Los Angeles USA.
⁵² General and Thoracic Surgery, Giessen Hospital, Giessen, Germany.
⁵³ 53Acute Care Surgery and Traumatology, Taipei Medical University Hospital, Taipei City, Taiwan, Republic of China.
⁵⁴ 54Trauma and Acute Care Surgery, Fundacion Valle del Lili, Cali, Colombia.
⁵⁵ 55Trauma and Acute Care Service, St Michael's Hospital, Toronto, ON Canada.
⁵⁶ Hospital Universitário Terezinha de Jesus, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, Brazil.
⁵⁷ Trauma, Acute Care Surgery, Medical College of Wisconsin/Froedtert Trauma Center, Milwaukee, WI USA.
⁵⁸ 58Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India.
⁵⁹ 59Department of Surgery and Obs/Gyn, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
⁶⁰ 60Milpark Hospital Academic Trauma Center, University of the Witwatersrand, Johannesburg, South Africa.
⁶¹ 61Acute Care Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI USA.
⁶² Emergency and Trauma Surgery, Parma Maggiore Hospital, Parma, Italy.

PMID: 29434652
PMCID: PMC5797335
DOI: 10.1186/s13017-018-0167-4

Review

The open abdomen in trauma and non-trauma patients: WSES guidelines

Federico Coccolini et al. World J Emerg Surg. 2018.

. 2018 Feb 2:13:7.

doi: 10.1186/s13017-018-0167-4. eCollection 2018.

Authors

Affiliations

¹ 1General Emergency and Trauma Surgery, Bufalini Hospital, Viale Giovanni Ghirotti, 286, 47521 Cesena, Italy.
² 2Department of Surgery, Foothills Medical Centre, Calgary, Canada.
³ 3Virginia Commonwealth University, Richmond, VA USA.
⁴ 4ICU Department, Bufalini Hospital, Cesena, Italy.
⁵ 5Division of General Surgery, Rambam Health Care Campus, Haifa, Israel.
⁶ 6Trauma Surgery, Denver Health, Denver, CO USA.
⁷ 7Department of Surgery, UC San Diego Health System, San Diego, USA.
⁸ 8Faculdade de Ciências Médicas (FCM)-Unicamp Campinas, Campinas, SP Brazil.
⁹ 9Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
¹⁰ Department of Surgery, Macerata Hospital, Macerata, Italy.
¹¹ 11Department of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA USA.
¹² Second Department of Surgery, Meilahti Hospital, Helsinki, Finland.
¹³ 13Trauma and Acute Care Surgery and Surgical Critical Care Trauma, Department of Surgery, University of California, Davis, USA.
¹⁴ 14General and Emergency Surgery, McGill University Health Centre, Montréal, QC Canada.
¹⁵ Department of Surgery, Harborview Medical Centre, Seattle, USA.
¹⁶ 16General Surgery Department, Hadassah Medical Centre, Jerusalem, Israel.
¹⁷ First Clinic of General Surgery, University Hospital/UMBAL/St George Plovdiv, Plovdiv, Bulgaria.
¹⁸ General Surgery, Mozir Hospital, Mozir City, Belarus.
¹⁹ ICU and High Care Burn Unit, Ziekenhius Netwerk Antwerpen, Antwerpen, Belgium.
²⁰ 20Department of Surgery, Trauma and Surgical Services, University of Pittsburgh School of Medicine, Pittsburgh, USA.
²¹ Department of Surgery, Tbilisi State Medical University, Kipshidze Central University Hospital, Tbilisi, Georgia.
²² General Surgery Department, Letterkenny Hospital, Letterkenny, Ireland.
²³ 23Addenbrooke's Hospital, Cambridge, UK.
²⁴ 24Klinik für Unfall-, Hand- und Wiederherstellungschirurgie Universitätsklinikum Goethe-Universität Frankfurt, Frankfurt, Germany.
²⁵ 25Department of Clinical Medicine, University of Bergen, Bergen, Norway.
²⁶ 26Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
²⁷ 27Acute Care Surgery, The Queen's Medical Center, Honolulu, HI USA.
²⁸ 28General and Trauma Surgery Department, London Health Sciences Centre, Victoria Hospital, London, ON Canada.
²⁹ 29Département d'Anesthésie-Réanimation, CHU Bichat Claude-Bernard-HUPNVS, Assistance Publique-Hôpitaux de Paris, University Denis Diderot, Paris, France.
³⁰ 30ICU Department, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
³¹ 31ICU Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.
³² 32Surgery Department, University of Maryland School of Medicine, Baltimore, MD USA.
³³ 33Emergency and Trauma Surgery Department, Niguarda Hospital, Milano, Italy.
³⁴ 34General Surgery Department, Assuta Medical Centers, Tel Aviv, Israel.
³⁵ General Surgery, "General Calixto García", Habana Medicine University, Havana, Cuba.
³⁶ General Surgery, Medical Faculty "General Calixto Garcia", Habana Medicine University, Havana, Cuba.
³⁷ Division of Trauma, Department of Surgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan, Republic of China.
³⁸ 38Clin. Univ. de Chirurgie Digestive et de l'Urgence, CHUGA-CHU Grenoble Alpes UGA-Université Grenoble Alpes, Grenoble, France.
³⁹ General and Emergency Surgery Department, Empoli Hospital, Empoli, Italy.
⁴⁰ 40Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital and Örebro University, Orebro, Sweden.
⁴¹ General Surgery, Perpignan Hospital, Perpignan, France.
⁴² 42Pediatric Trauma Service, Massachusetts General Hospital, Boston, MA USA.
⁴³ General and Emergency Surgery, Sergei Kirov Military Academy, Saint Petersburg, Russia.
⁴⁴ 44Unit of Digestive Surgery, HPB Surgery and Liver Transplant, Henri Mondor Hospital, Créteil, France.
⁴⁵ 45Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
⁴⁶ 46Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia.
⁴⁷ 47General Surgery Department, Westchester Medical Center, Westchester, NY USA.
⁴⁸ 48Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
⁴⁹ 49Department of General Surgery, Royal Perth Hospital, The University of Western Australia & The University of Newcastle, Perth, Australia.
⁵⁰ 50Trauma Unit, Helsinki University Hospital, Helsinki, Finland.
⁵¹ 51Division of Trauma and Critical Care, LAC+USC Medical Center, University of Southern California, California, Los Angeles USA.
⁵² General and Thoracic Surgery, Giessen Hospital, Giessen, Germany.
⁵³ 53Acute Care Surgery and Traumatology, Taipei Medical University Hospital, Taipei City, Taiwan, Republic of China.
⁵⁴ 54Trauma and Acute Care Surgery, Fundacion Valle del Lili, Cali, Colombia.
⁵⁵ 55Trauma and Acute Care Service, St Michael's Hospital, Toronto, ON Canada.
⁵⁶ Hospital Universitário Terezinha de Jesus, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, Brazil.
⁵⁷ Trauma, Acute Care Surgery, Medical College of Wisconsin/Froedtert Trauma Center, Milwaukee, WI USA.
⁵⁸ 58Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India.
⁵⁹ 59Department of Surgery and Obs/Gyn, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
⁶⁰ 60Milpark Hospital Academic Trauma Center, University of the Witwatersrand, Johannesburg, South Africa.
⁶¹ 61Acute Care Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI USA.
⁶² Emergency and Trauma Surgery, Parma Maggiore Hospital, Parma, Italy.

PMID: 29434652
PMCID: PMC5797335
DOI: 10.1186/s13017-018-0167-4

Abstract

Damage control resuscitation may lead to postoperative intra-abdominal hypertension or abdominal compartment syndrome. These conditions may result in a vicious, self-perpetuating cycle leading to severe physiologic derangements and multiorgan failure unless interrupted by abdominal (surgical or other) decompression. Further, in some clinical situations, the abdomen cannot be closed due to the visceral edema, the inability to control the compelling source of infection or the necessity to re-explore (as a "planned second-look" laparotomy) or complete previously initiated damage control procedures or in cases of abdominal wall disruption. The open abdomen in trauma and non-trauma patients has been proposed to be effective in preventing or treating deranged physiology in patients with severe injuries or critical illness when no other perceived options exist. Its use, however, remains controversial as it is resource consuming and represents a non-anatomic situation with the potential for severe adverse effects. Its use, therefore, should only be considered in patients who would most benefit from it. Abdominal fascia-to-fascia closure should be done as soon as the patient can physiologically tolerate it. All precautions to minimize complications should be implemented.

Keywords: Biological; Closure; Fistula; Guidelines; Intra-abdominal infection; Laparostomy; Mesh; Non-trauma; Nutrition; Open abdomen; Pancreatitis; Peritonitis; Re-exploration; Reintervention; Synthetic; Technique; Timing; Trauma; Vascular emergencies.

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Conflict of interest statement

Not applicableNot applicableThe authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

**Fig. 1**
WSACS grading of intra-abdominal hypertension (IAH) (IAP intra-abdominal pressure, ACS abdominal compartment syndrome) [4]

**Fig. 2**
Open Abdomen classification according to Björck et al. [147]

See this image and copyright information in PMC

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References

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1. Sartelli M, Abu-Zidan FM, Ansaloni L, Bala M, Beltrán MA, Biffl WL, et al. The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper. World J Emerg Surg. 2015;10:35. - PMC - PubMed
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[1] Bailey J, Shapiro MJ. Abdominal compartment syndrome. Crit Care. 2000;4:23–29. - PMC - PubMed

[2] Bailey J, Shapiro MJ. Abdominal compartment syndrome. Crit Care. 2000;4:23–29. - PMC - PubMed

[3] Sartelli M, Abu-Zidan FM, Ansaloni L, Bala M, Beltrán MA, Biffl WL, et al. The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper. World J Emerg Surg. 2015;10:35. - PMC - PubMed

[4] Sartelli M, Abu-Zidan FM, Ansaloni L, Bala M, Beltrán MA, Biffl WL, et al. The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper. World J Emerg Surg. 2015;10:35. - PMC - PubMed

[5] Coccolini F, Montori G, Ceresoli M, Catena F, Moore EE, Ivatury R, et al. The role of open abdomen in non-trauma patient: WSES Consensus Paper. World J Emerg Surg. 2017;12:39. - PMC - PubMed

[6] Coccolini F, Montori G, Ceresoli M, Catena F, Moore EE, Ivatury R, et al. The role of open abdomen in non-trauma patient: WSES Consensus Paper. World J Emerg Surg. 2017;12:39. - PMC - PubMed

[7] Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain MLNG, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39:1190–1206. - PMC - PubMed

[8] Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain MLNG, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39:1190–1206. - PMC - PubMed

[9] Leppäniemi AK. Laparostomy: why and when? Crit Care. 2010;14:216. - PMC - PubMed

[10] Leppäniemi AK. Laparostomy: why and when? Crit Care. 2010;14:216. - PMC - PubMed

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The open abdomen in trauma and non-trauma patients: WSES guidelines

Affiliations

The open abdomen in trauma and non-trauma patients: WSES guidelines

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Abstract

Conflict of interest statement

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