A proposed algorithm for managing the open abdomen

James Cipolla, Stanislaw P. Stawicki, William S. Hoff, Nathaniel McQuay, Brian A. Hoey, Gail Wainwright, Michael D. Grossman

Research output: Contribution to journalArticle

Abstract

Delayed abdominal closure has gained acceptance in managing a variety of surgical conditions. Multiple techniques were devised to promote safe, uncomplicated, expeditious fascial closure. We retrospectively reviewed patient records between September 22, 2001 and June 30, 2004. Of the 20 patients with open abdomen, two patients died within 24 hours and one was transferred. The remaining 17 were managed using an algorithm including a combination of delayed primary closure (DPC), vacuum-assisted fascial closure (VAFC), Wittmann Patch (WP) (Star Surgical, Inc., Burlington, WI), and planned ventral hernia via absorbable mesh with split thickness skin grafting (PVH). The mean Simplified Acute Physiology Scores (SAPS II) was 31 (predicted mortality 73%). All patients initially underwent VAFC and re-exploration 12-48 hours later. Indications for continued VAFC included 1) gross contamination, 2) massive bowel edema, 3) continued bleeding at re-exploration. If these conditions were absent, DPC was attempted or a WP was employed until fascial closure. Twenty-eight day mortality was 5.9 per cent (1/17 patients). Enterocutaneous fistulae occurred in two patients (11.7%). Fascial closure was achieved in 6 patients (35.3%). Eleven patients were managed with PVH. Using an algorithm with a combination of several techniques, open abdomen can be managed with minimal morbidity and acceptable closure rates.

Original languageEnglish (US)
Pages (from-to)202-207
Number of pages6
JournalAmerican Surgeon
Volume71
Issue number3
StatePublished - 2005
Externally publishedYes

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Abdomen
Negative-Pressure Wound Therapy
Ventral Hernia
Intestinal Fistula
Skin Transplantation
Mortality
Edema
Hemorrhage
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Cipolla, J., Stawicki, S. P., Hoff, W. S., McQuay, N., Hoey, B. A., Wainwright, G., & Grossman, M. D. (2005). A proposed algorithm for managing the open abdomen. American Surgeon, 71(3), 202-207.

A proposed algorithm for managing the open abdomen. / Cipolla, James; Stawicki, Stanislaw P.; Hoff, William S.; McQuay, Nathaniel; Hoey, Brian A.; Wainwright, Gail; Grossman, Michael D.

In: American Surgeon, Vol. 71, No. 3, 2005, p. 202-207.

Research output: Contribution to journalArticle

Cipolla, J, Stawicki, SP, Hoff, WS, McQuay, N, Hoey, BA, Wainwright, G & Grossman, MD 2005, 'A proposed algorithm for managing the open abdomen', American Surgeon, vol. 71, no. 3, pp. 202-207.
Cipolla J, Stawicki SP, Hoff WS, McQuay N, Hoey BA, Wainwright G et al. A proposed algorithm for managing the open abdomen. American Surgeon. 2005;71(3):202-207.
Cipolla, James ; Stawicki, Stanislaw P. ; Hoff, William S. ; McQuay, Nathaniel ; Hoey, Brian A. ; Wainwright, Gail ; Grossman, Michael D. / A proposed algorithm for managing the open abdomen. In: American Surgeon. 2005 ; Vol. 71, No. 3. pp. 202-207.
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