Temporary closure of the abdominal wall (laparostomy) |
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Authors: | A Schachtrupp V Fackeldey U Klinge J Hoer A Tittel C Toens V Schumpelick |
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Institution: | (1) Department of Surgery, Rhenish Westphalian Technical University, Pauwelsstr. 30, 52074 Aachen, Germany, |
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Abstract: | The definitive closure of the abdominal wall, i.e., a closure of the fascial layer and skin may not be favorable in the treatment
of numerous surgical conditions, e.g., peritonitis, trauma, or mesenteric ischemia. In these cases, the abdominal wall is
temporarily closed, and a laparostomy is created to facilitate re-exploration or to prevent abdominal compartment syndrome.
Regarding the technique and material used for the temporary closure, no prospective randomized data exists, but mesh materials
are commonly used. They provide drainage of infectious material, permit visual control of the underlying viscera, facilitate
access to the abdominal wall, preserve the fascial margin, enable healing by secondary intention, and allow mobilization of
the patient. In the case of decreasing intra-abdominal pressure, meshes can be trimmed to centralize the rectus muscle and
to facilitate definitive closure. Non-absorbable meshes have been frequently reported to cause enteric fistulae and persistent
infection necessitating mesh explantation. While these infectious complications appear to occur less frequently with the use
of absorbable materials, these meshes will finally lead to an incisional hernia, requiring repair with non-absorbable mesh
after a period of 6–12 months. Nevertheless, in the complex situation requiring a temporary abdominal wall closure, use of
absorbable mesh material is common and represents the state of the art.
Electronic Publication |
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Keywords: | Temporary abdominal closure Laparostomy Peritonitis Damage control Abdominal compartment |
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