Direct Peritoneal Resuscitation: A Novel Adjunct to Damage Control Laparotomy

2019 ◽  
Vol 39 (6) ◽  
pp. 37-45
Author(s):  
Steven Wiseman ◽  
Ellen M. Harvey ◽  
Katie Love Bower
Keyword(s):  
Open Abdomen ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Care Practice ◽  
Successful Implementation ◽  
Resuscitation Strategy ◽  
Physiological Benefits ◽  
Procedural Components ◽  
Management Priorities ◽  
Abdominal Compartment

Direct peritoneal resuscitation is a validated resuscitation strategy for patients undergoing damage control surgery for hemorrhage, sepsis, or abdominal compartment syndrome with open abdomen and planned reexploration after a period of resuscitation in the intensive care unit. Direct peritoneal resuscitation can decrease visceral edema, normalize body water ratios, accelerate primary abdominal wall closure after damage control surgery, and prevent complications associated with open abdomen. This review article describes the physiological benefits of direct peritoneal resuscitation, how this technique fits within management priorities for the patient in shock, and procedural components in the care of open abdomen surgical patients receiving direct peritoneal resuscitation. Strategies for successful implementation of a novel multidisciplinary intervention in critical care practice are explored.

The open abdomen

2021 ◽  
pp. 1179-1184
Author(s):  
Omar A. Khan ◽  
Emma Rose McGlone ◽  
Marcus Reddy
Keyword(s):  
Negative Pressure ◽  
Open Abdomen ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Temporary Abdominal Closure ◽  
Systemic Complications ◽  
Advantages And Disadvantages ◽  
Abdominal Closure ◽  
Local And Systemic Complications ◽  
Abdominal Compartment

This chapter introduces the concept of the open abdomen and describes the various aetiologies of this complex condition, including the rationale for elective laparostomy in damage control surgery and as a treatment for abdominal compartment syndrome. The significance of the open abdomen is described in terms of its local and systemic complications, which form the basis of the established classification. Important considerations in the acute systemic management of patients with this condition are outlined, and methods of temporary abdominal closure are described. Advantages and disadvantages of these alternatives, including the use of negative-pressure wound therapy, are discussed.

Operative Exposure of Abdominal Injuries and Closure of the Abdomen

2019 ◽  
Author(s):  
Matthew D Nealeigh ◽  
Mark W Bowyer
Keyword(s):  
Open Abdomen ◽  
Nonoperative Management ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Damage Control Resuscitation ◽  
Abdominal Injuries ◽  
Penetrating Injuries ◽  
Optimal Outcomes ◽  
Medial Rotation ◽  
Selective Nonoperative Management

Operative exposure and management of significant blunt or penetrating injuries to the abdomen is a critical skill required of all surgeons caring for victims of trauma. Application of damage control resuscitation and damage control surgical principles improves survival. Advances in diagnostics, increasing experience with selective nonoperative management, and use of endovascular and angiographic techniques have all significantly decreased the frequency of laparotomies performed for trauma. This decreasing clinical experience mandates that surgeons dealing with victims of trauma remain facile with the operative approaches and techniques detailed in this chapter to achieve optimal outcomes. Detailed management of specific injuries is covered in other chapters of this text. This review contains 7 figures, 2 tables, and 41 references.  Key Words: abdominal trauma, damage control resuscitation, damage control surgery, endovascular control of hemorrhage, open abdomen, REBOA, supraceliac control of aorta, trauma systems, visceral medial rotation

scholarly journals Damage-control surgery in patients with non-traumatic abdominal emergencies: A meta-analysis

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
T Haltmeier ◽  
M Falke ◽  
O Quaile ◽  
D Candinas ◽  
B Schnüriger
Keyword(s):  
Mortality Rate ◽  
Literature Search ◽  
Damage Control ◽  
Meta Analysis ◽  
Damage Control Surgery ◽  
Categorical Variables ◽  
Successful Implementation ◽  
Abdominal Emergencies ◽  
Meta Analyses ◽  
Expected Mortality

Abstract Objective After the successful implementation in trauma patients, damage control surgery (DCS) is being increasingly used in non-traumatic abdominal emergencies, too. However, non-trauma DCS (NT-DCS) is currently a matter of debate and has not yet been comprehensively assessed. The aim of this meta-analysis was to investigate the effect of NT-DCS on mortality in patients with abdominal emergencies. Methods Systematic literature search using PubMed. Original articles addressing mortality in patients undergoing NT-DCS or non-trauma conventional surgery (NT-CS) for abdominal emergencies were included. Descriptive statistics and two meta-analyses were performed. Meta-analysis 1 compared mortality in patients undergoing NT-DCS vs. NT-CS. Meta-analysis 2 assessed the observed vs. expected mortality rate, based on APACHE, POSSUM and SAPS scores, in the NT-DCS group. Continuous and categorical variables were reported as weighted means and proportions. Effect sizes were described as risk differences (RD) with 95% confidence intervals (CI). Results Literature search revealed 1314 articles. Of these, 21 studies published 2004-2019 were included. NT-DCS was performed in 1238 and NT-CS in 936 patients. In the NT-DCS vs. NT-CS group mean age was 61.0 vs. 64.9 years and the proportion of male patients 58.6% vs. 52.9%, respectively. Most frequent indications for NT-DCS were hollow viscus perforation (28.4%), mesenteric ischemia (26.5%), anastomotic leak (19.6%), haemorrhage (18.4%), abdominal compartment syndrome (17.4%), bowel obstruction (15.5%), and pancreatitis (13.1%). In meta-analysis 1, mortality was not significantly different in the NT-DCS vs. NT-CS group (RD 0.09, 95% CI -0.06/0.24). Meta-analysis 2 revealed a significantly lower observed than the expected mortality rate in patients undergoing NT-DCS (RD -0.18, 95 % CI -0.29/-0.06). Heterogeneity of included studies was high in both meta-analyses (I2=89.0% and 79.9%, respectively). Conclusion This meta-analysis revealed no significantly different mortality in patients with abdominal emergencies undergoing NT-DCS vs. NT-CS. However, observed mortality was significantly lower than the expected mortality rate in the NT-DCS group, suggesting a benefit of the DCS approach. Based on these results, the effect of DCS in patients with non-traumatic abdominal emergencies remains unclear. Further prospective investigation into this topic is warranted.

scholarly journals Current Status of the Open Abdomen Treatment for Intra-Abdominal Infection

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Yujie Yuan ◽  
Jianan Ren ◽  
Yulong He
Keyword(s):  
Open Abdomen ◽  
Damage Control ◽  
Fluid Management ◽  
Damage Control Surgery ◽  
Skin Grafting ◽  
Current Status ◽  
Fascial Closure ◽  
Surgical Interventions ◽  
Abdominal Infection ◽  
Intra Abdominal Infection

The open abdomen has become an important approach for critically ill patients who require emergent abdominal surgical interventions. This treatment, originating from the concept of damage control surgery, was first applied in severe traumatic patients. The ultimate goal is to achieve formal abdominal fascial closure by several attempts and adjuvant therapies (fluid management, nutritional support, skin grafting, etc.). Up to the present, open abdomen therapy becomes matured and is multistage-approached in the management of patients with severe trauma. However, its application in patients with intra-abdominal infection still presents great challenges due to critical complications and poor clinical outcomes. This review focuses on the specific use of the open abdomen in such populations and detailedly introduces current concerns and advanced progress about this therapy.

scholarly journals Challenge of uncontrolled enteroatmospheric fistulas

2019 ◽  
Vol 4 (1) ◽  
pp. e000381
Author(s):  
Daniel Jonathan Gross ◽  
Michael C Smith ◽  
Bardiya Zangbar-Sabegh ◽  
Kenneth Chao ◽  
Erin Chang ◽  
...  
Keyword(s):  
Open Abdomen ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Control Technique ◽  
Source Control ◽  
Surgical Intensive Care Unit ◽  
Closure Device ◽  
Surgical Intensive Care ◽  
The Individual ◽  
Temporary Closure

IntroductionWith the popularization of damage control surgery and the use of the open abdomen, a new permutation of fistula arose; the enteroatmospheric fistula (EAF), an opening of exposed intestine spilling uncontrollably into the peritoneal cavity. EAF is the most devastating complication of the open abdomen. We describe and analyze a single institution’s experience in controlling high-output EAFs in patients with peritonitis.MethodsWe analyzed 189 consecutive procedures to achieve and maintain definitive control of 24 EAFs in 13 patients between 2006 and 2017. EAFs followed surgery for either trauma (seven patients) or non-traumatic abdominal conditions (six patients). All procedures were mapped onto an operative timeline and analyzed for: success in achieving definitive control, number of reoperations, and feasibility of bedside procedures in the surgical intensive care unit. The end point was controlled enteric drainage through a healed abdominal wound.ResultsThere was a mean delay of 8.5 days (range 2–46 days) from the index operation until the EAF was identified. Most EAFs required several attempts (mean: 2.7 per patient, range 1–7) until definitive control was achieved. Multiple reoperations were then required to maintain control (mean: 13). While the most effective techniques were endoscopic (1) and proximal diversion (1), these were applicable only in select circumstances. A ‘floating stoma’ where the fistula edges are sutured to an opening in a temporary closure device, while technically effective, required multiple reoperations. Tube drainage through a negative pressure dressing (tube vac) required the most maintenance usually through bedside procedures. Primary closure almost always failed. Twelve of the 13 patients survived.ConclusionAn EAF is a highly complex surgical challenge. Successful source control of the potentially lethal ongoing peritonitis requires tenacity and tactical flexibility. The appropriate control technique is often found by trial and error and must be creatively tailored to the individual circumstances of the patient.

scholarly journals Predictive factors of mortality in open abdomen for abdominal sepsis: a retrospective cohort study on 113 patients

2021 ◽  
Author(s):  
Dario Tartaglia ◽  
Jacopo Nicolò Marin ◽  
Alice Maria Nicoli ◽  
Andrea De Palma ◽  
Martina Picchi ◽  
...  
Keyword(s):  
Predictive Factors ◽  
Open Abdomen ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Abdominal Sepsis ◽  
Apache Ii ◽  
Fascial Closure ◽  
Apache Ii Score ◽  
Co Morbidity ◽  
Fistula Rate

AbstractOver the past few years, the open abdomen (OA) as a part of Damage Control Surgery (DCS) has been introduced as a surgical strategy with the intent to reduce the mortality of patients with severe abdominal sepsis. Aims of our study were to analyze the OA effects on patients with abdominal sepsis and identify predictive factors of mortality. Patients admitted to our institution with abdominal sepsis requiring OA from 2010 to 2019 were retrospectively analyzed. Primary outcomes were mortality, morbidity and definitive fascial closure (DFC). Comparison between groups was made via univariate and multivariate analyses. On 1474 patients operated for abdominal sepsis, 113 (7.6%) underwent OA. Male gender accounted for 52.2% of cases. Mean age was 68.1 ± 14.3 years. ASA score was > 2 in 87.9%. Mean BMI, APACHE II score and Mannheim Peritonitis Index were 26.4 ± 4.9, 15.3 ± 6.3, and 22.6 ± 7.3, respectively. A negative pressure wound system technique was used in 47% of the cases. Overall, mortality was 43.4%, morbidity 76.6%, and DFC rate was 97.8%. Entero-atmospheric fistula rate was 2.2%. At multivariate analysis, APACHE II score (OR 1.18; 95% CI 1.05–1.32; p = 0.005), Frailty Clinical Scale (OR 4.66; 95% CI 3.19–6.12; p < 0.0001) and ASA grade IV (OR 7.86; 95% CI 2.18–28.27; p = 0.002) were significantly associated with mortality. OA seems to be a safe and reliable treatment for critically ill patients with severe abdominal sepsis. Nonetheless, in these patients, co-morbidity and organ failure remain the major obstacles to a better prognosis.

scholarly journals Experience of the MALA Bag in the Open Abdomen Management in an Obstetrical Intensive Care Unit

2013 ◽  
Vol 26 (6) ◽  
pp. 699
Author(s):  
María de Jesús Angeles Vásquez ◽  
Luis Emilio Reyes Mendoza ◽  
Ricardo Mauricio Malagón Reyes ◽  
Hugo Mendieta Zerón
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Open Abdomen ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Abdominal Sepsis ◽  
History Of ◽  
The Mean ◽  
Surgical Option ◽  
Previous Cesarean

Introduction: Current indications for open abdomen management are damage control surgery, severe intra-abdominal sepsis, abdominal compartment syndrome, abdominal wall closure under tension and mass loss of the abdominal wall.Objective: To describe the experience in open abdomen management using the MALA (mayor absorción de líquido abdominal [greater absorption of abdominal liquid]) bag at the Maternal-Perinatal Hospital Mónica Pretelini Saénz, Health Institute of the State of Mexico.Material and Methods: This was a bidirectional, descriptive and observational study. All patients with the diagnosis of open abdomen managed with the MALA bag admitted to the Obstetric Intensive Care Unit from February 2009 to June 2012 were included.Results: From 25 cases identified in the period of the study, seven were eliminated for incomplete files, remaining 18 cases for the analysis. The mean age was 31.5 years. 78% of the patients were multigravidas, 50% of them with a history of 2 or more deliveries, 83% had a previous cesarean section and 78% were hysterectomized. Evisceration was present in one patient. The main indication for surgical management was damage control. One patient died and a second was transferred to another institution, the rest were discharged by clinical improvement. 12 patients (67%) spent less than 14 days in the Obstetric Intensive Care Unit, only one patient required morethan 30 days in the unit. Discussion: Halve the women who required this surgical alternative, were above 30 years of age. Stressing is the fact that from the 18 admitted patients, 14 (78%) had undergone obstetric hysterectomy, with the etiology of uterine atony in most cases. Damage control surgery seems to be the most elective surgical option to use MALA bag followed by ACS and abdominal sepsis.Conclusion: The MALA bag can offer an economic and effective surgical option for the open abdomen management as well as adrainage technique.

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