Multidisciplinary approach to abdominal wall reconstruction after decompressive laparotomy for abdominal compartment syndrome

Charles Hultman, Broc Pratt, Bruce A. Cairns, Lindsee McPhail, Edmund J. Rutherford, Preston B. Rich, Christopher C. Baker, Anthony A. Meyer, Detlev Erdmann

Research output: Contribution to journalReview article

Abstract

Introduction: Decompressive laparotomy for abdominal compartment syndrome has been shown to reduce mortality in critically ill patients, but little is known about the outcome of abdominal wall reconstruction. This study investigates the role of plastic surgeons in the management and reconstruction of these abdominal wall defects. Methods: We performed a retrospective review of 82 consecutive critically ill patients who underwent decompressive laparotomy for abdominal compartment syndrome, at a university level 1 trauma center, from April 2000 to May 2004. Patients reconstructed by trauma surgeons alone (n = 15) were compared with patients reconstructed jointly with plastic surgeons (n = 12), using Student t test and χ2 analysis. Results: Eighty-two patients underwent decompressive laparotomy for abdominal compartment syndrome, yielding 50 survivors (61%). Of the 27 patients who underwent abdominal wall reconstruction, 6 had early primary fascial repair, and 21 had staged reconstruction with primary fascial closure (n = 4), components separation alone (n = 3), components separation with mesh (n = 10), or permanent mesh only (n = 4). Compared with patients whose reconstruction was performed by trauma surgeons, patients who underwent a combined approach with plastic surgeons were older (50.5 versus 31.7 years, P < 0.05), had more comorbidities (P < 0.001), were less likely to have a traumatic etiology (P < 0.001), had a longer delay to reconstruction (407 versus 119 days, P < 0.05), and were more likely to undergo components separation (P < 0.05). Mean follow-up of 11.5 months revealed 2 recurrent hernias in the combined reconstruction group, both of which were successfully repaired. Conclusions: A multidisciplinary approach is essential to the successful management of abdominal wall defects after decompressive laparotomy for abdominal compartment syndrome. Although carefully selected patients can undergo early primary fascial repair, most of reconstructed patients had staged closure of the abdominal wall via components separation, with a low rate of recurrent hernia. High-risk patients with large defects and comorbidities appear to benefit from the involvement of a plastic surgeon.

Original languageEnglish (US)
Pages (from-to)269-275
Number of pages7
JournalAnnals of plastic surgery
Volume54
Issue number3
DOIs
StatePublished - Mar 1 2005
Externally publishedYes

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Intra-Abdominal Hypertension
Abdominal Wall
Laparotomy
Hernia
Critical Illness
Comorbidity
Trauma Centers
Wounds and Injuries
Survivors
Surgeons

Keywords

  • Abdominal compartment syndrome
  • Abdominal wall reconstruction
  • Decompressive laparotomy

ASJC Scopus subject areas

  • Surgery

Cite this

Multidisciplinary approach to abdominal wall reconstruction after decompressive laparotomy for abdominal compartment syndrome. / Hultman, Charles; Pratt, Broc; Cairns, Bruce A.; McPhail, Lindsee; Rutherford, Edmund J.; Rich, Preston B.; Baker, Christopher C.; Meyer, Anthony A.; Erdmann, Detlev.

In: Annals of plastic surgery, Vol. 54, No. 3, 01.03.2005, p. 269-275.

Research output: Contribution to journalReview article

Hultman, C, Pratt, B, Cairns, BA, McPhail, L, Rutherford, EJ, Rich, PB, Baker, CC, Meyer, AA & Erdmann, D 2005, 'Multidisciplinary approach to abdominal wall reconstruction after decompressive laparotomy for abdominal compartment syndrome', Annals of plastic surgery, vol. 54, no. 3, pp. 269-275. https://doi.org/10.1097/01.sap.0000153084.02657.61
Hultman, Charles ; Pratt, Broc ; Cairns, Bruce A. ; McPhail, Lindsee ; Rutherford, Edmund J. ; Rich, Preston B. ; Baker, Christopher C. ; Meyer, Anthony A. ; Erdmann, Detlev. / Multidisciplinary approach to abdominal wall reconstruction after decompressive laparotomy for abdominal compartment syndrome. In: Annals of plastic surgery. 2005 ; Vol. 54, No. 3. pp. 269-275.
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AU - Pratt, Broc

AU - Cairns, Bruce A.

AU - McPhail, Lindsee

AU - Rutherford, Edmund J.

AU - Rich, Preston B.

AU - Baker, Christopher C.

AU - Meyer, Anthony A.

AU - Erdmann, Detlev

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N2 - Introduction: Decompressive laparotomy for abdominal compartment syndrome has been shown to reduce mortality in critically ill patients, but little is known about the outcome of abdominal wall reconstruction. This study investigates the role of plastic surgeons in the management and reconstruction of these abdominal wall defects. Methods: We performed a retrospective review of 82 consecutive critically ill patients who underwent decompressive laparotomy for abdominal compartment syndrome, at a university level 1 trauma center, from April 2000 to May 2004. Patients reconstructed by trauma surgeons alone (n = 15) were compared with patients reconstructed jointly with plastic surgeons (n = 12), using Student t test and χ2 analysis. Results: Eighty-two patients underwent decompressive laparotomy for abdominal compartment syndrome, yielding 50 survivors (61%). Of the 27 patients who underwent abdominal wall reconstruction, 6 had early primary fascial repair, and 21 had staged reconstruction with primary fascial closure (n = 4), components separation alone (n = 3), components separation with mesh (n = 10), or permanent mesh only (n = 4). Compared with patients whose reconstruction was performed by trauma surgeons, patients who underwent a combined approach with plastic surgeons were older (50.5 versus 31.7 years, P < 0.05), had more comorbidities (P < 0.001), were less likely to have a traumatic etiology (P < 0.001), had a longer delay to reconstruction (407 versus 119 days, P < 0.05), and were more likely to undergo components separation (P < 0.05). Mean follow-up of 11.5 months revealed 2 recurrent hernias in the combined reconstruction group, both of which were successfully repaired. Conclusions: A multidisciplinary approach is essential to the successful management of abdominal wall defects after decompressive laparotomy for abdominal compartment syndrome. Although carefully selected patients can undergo early primary fascial repair, most of reconstructed patients had staged closure of the abdominal wall via components separation, with a low rate of recurrent hernia. High-risk patients with large defects and comorbidities appear to benefit from the involvement of a plastic surgeon.

AB - Introduction: Decompressive laparotomy for abdominal compartment syndrome has been shown to reduce mortality in critically ill patients, but little is known about the outcome of abdominal wall reconstruction. This study investigates the role of plastic surgeons in the management and reconstruction of these abdominal wall defects. Methods: We performed a retrospective review of 82 consecutive critically ill patients who underwent decompressive laparotomy for abdominal compartment syndrome, at a university level 1 trauma center, from April 2000 to May 2004. Patients reconstructed by trauma surgeons alone (n = 15) were compared with patients reconstructed jointly with plastic surgeons (n = 12), using Student t test and χ2 analysis. Results: Eighty-two patients underwent decompressive laparotomy for abdominal compartment syndrome, yielding 50 survivors (61%). Of the 27 patients who underwent abdominal wall reconstruction, 6 had early primary fascial repair, and 21 had staged reconstruction with primary fascial closure (n = 4), components separation alone (n = 3), components separation with mesh (n = 10), or permanent mesh only (n = 4). Compared with patients whose reconstruction was performed by trauma surgeons, patients who underwent a combined approach with plastic surgeons were older (50.5 versus 31.7 years, P < 0.05), had more comorbidities (P < 0.001), were less likely to have a traumatic etiology (P < 0.001), had a longer delay to reconstruction (407 versus 119 days, P < 0.05), and were more likely to undergo components separation (P < 0.05). Mean follow-up of 11.5 months revealed 2 recurrent hernias in the combined reconstruction group, both of which were successfully repaired. Conclusions: A multidisciplinary approach is essential to the successful management of abdominal wall defects after decompressive laparotomy for abdominal compartment syndrome. Although carefully selected patients can undergo early primary fascial repair, most of reconstructed patients had staged closure of the abdominal wall via components separation, with a low rate of recurrent hernia. High-risk patients with large defects and comorbidities appear to benefit from the involvement of a plastic surgeon.

KW - Abdominal compartment syndrome

KW - Abdominal wall reconstruction

KW - Decompressive laparotomy

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