Nonoperative progressive "Bogota bag" closure after abdominal decompression

"Bogota bags" are often used for temporary abdominal closure after damage control or staged laparotomy for trauma or release of abdominal compartment syndrome. After placement of the Bogota bag serial operative closures are required to return abdominal contents to their original location before definitive closure. Unnecessary operative procedures may be avoided when binder clips are used to facilitate the gradual approximation of the wound edges before abdominal closure.     

The effect of different temporary abdominal closure techniques on fascial wound healing and postoperative adhesions in experimental secondary peritonitis

Background Secondary peritonitis causes considerable mortality and morbidity. New strategies have been introduced like relaparotomy and temporary abdominal closure in the management of such persistent intra-abdominal infections. Materials and methods Rats were divided into five groups each having ten animals. After induction of peritonitis, relaparotomies were done, and the abdomen was closed by different temporary abdominal closure techniques. After performing two relaparotomies during a 48-h period, all fascias closed primarily and incisional tensile strengths, hydroxyproline contents, and adhesions were measured on the following seventh day. Results The median values of tensile strength and hydroxyproline concentrations were lowest in skin-only closure rats. Intraperitoneal adhesion scores were highest in Bogota bag closure group. Conclusion Primary, Bogota bag, and polyprolene mesh closures seem to be safe in terms of early fascial wound healing. Although it is easy to perform, skin-only closure technique has deleterious effects on fascial wound healing probably due to fascial retraction. Interestingly, Bogota bag has caused increased intraperitoneal adhesion formation.     

3升生理氯化钠溶液袋暂时性关腹的临床应用

目的探讨腹腔严重感染病人应用3升生理氯化钠溶液袋暂时性关腹技术的价值。方法回顾性分析2007年9月至2009年1月间7例严重腹腔感染应用3升生理氯化钠溶液袋暂时性关腹,观察治疗效果、预后。结果本组痊愈5例,无严重并发症出现,多器官功能衰竭死亡1例,放弃治疗1例。结论3升生理氯化钠溶液袋暂时性关腹技术是一种价格低廉、有效的特殊情况时使用的暂时性关腹手段。     

暂时性腹腔关闭技术在腹腔间隔室综合征中的应用

目的探讨暂时性腹腔关闭技术在腹腔间隔室综合征中的应用。方法总结我院2006年1月至2009年12月共13例腹腔间隔室综合征应用暂时性腹腔关闭技术患者的临床资料,分析其治疗方法和效果。结果本组13例患者中,死亡1例,其余12例行确定性关腹,暂时性腹腔关闭平均11．6（7～48）d;确定性腹腔关闭后,切口的愈合时间为（15．3±8．4）d。出现切口疝1例。结论暂时性腹腔关闭技术是治疗腹腔间隔室综合征有效、安全、经济的方法。     

Novel technique of temporary abdominal closure with continuous medial fascial traction dynamic for patients with open abdomen

Open abdomen has been an effective treatment for abdominal catastrophes in trauma and general surgery, is one of the greatest advances in recent decades and has become a common procedure in both trauma and general surgery. Temporary abdominal closure techniques in managing open abdomen help to achieve many benefits without incurring many complications. We present a series of patients in which a temporary abdominal closure technique was used that generates continuous medial fascial traction dynamic in patients with open abdomen for different causes.     

真空敷料装置在暂时性关腹中的应用

目的 探讨一种新的暂时性关腹方法一真空敷料装置的临床应用。方法 用聚丙烯薄膜、手术巾、塑料黏贴膜和引流管等构建真空敷料装置。记录使用此装置患者的各种临床资料和并发症。结果 有13例患者共使用真空包扎15次进行暂时性关腹，其中5次（33．3％）是因为腹内压增高无法获得无张力的筋膜对合，4次（26．7％）是为了再次手术探查，2次（13．3％）是因为损伤控制，4次（26．7％）是上述多个因素的联合。7例（53．8％）患者最终完成腹壁全层对合关闭，5例（38．5％）患者无法直接对合腹壁缺损，最后行创面断层皮片植皮；3例（23．1％）患者出现腹腔内脓肿，无1例出现消化道瘘，无内脏脱出。1例（7．7％）在试图关腹之前死亡，与真空包扎无关。结论 真空包扎可使患者获得直接腹壁肌肉筋膜层关闭，并发症发生率低、易于掌握，是一种较好的暂时性关腹方法。     

真空敷料用于暂时性关腹的临床研究

目的 探讨真空敷料在暂时性关腹中的应用。方法 对山东大学齐鲁医院1998—2005年35例不能无张力关腹或欲进行计划再剖腹的病人行暂时性关腹，分为2组，使用真空敷料暂时性关腹组（15例），与同期传统敷料组（20例）进行对比研究。结果 真空敷料组：腹壁全层对合关腹8例（53．3％），创面植皮6例（40．0％），1例（6．7％）关腹前死亡，2例（13．3％）出现腹腔脓肿，未出现消化道瘘。传统敷料组：腹壁全层对合关腹4例（20．0％），关腹率明显低于真空敷料组（P=0．040），创面植皮14例（70．0％），发生腹腔脓肿4例（20．0％），2例（10．0％）出现消化道瘘，创面植皮前死亡2例（10．0％）。两组均未出现内脏突出。结论 与传统暂时性关腹方法相比，应用真空敷料关腹率较高，并发症发生率较低，是一种较好的暂时性关腹方法。     

Surgical complications and causes of death in trauma patients that require temporary abdominal closure

Temporary abdominal closure (TAC) has increasingly been employed in the management of severely injured patients to avoid abdominal compartment syndrome (ACS) and as part of damage control surgery (DCS). Although the use of TAC has received great interest, few data exist describing the morbidity and mortality associated with its use in trauma victims. The main goal of this study is to describe the incidence of surgical complications following the use of TAC as well as to define the mortality associated with this procedure. A retrospective review of patients admitted to a state-designated level 1 trauma center from April 2000 to February 2003 was performed. Inclusion criteria were age >18 years, traumatic injury, and need for exploratory laparotomy and use of TAC. A total of 120 patients were included in the study. The overall mortality of trauma patients requiring TAC was 59.2 per cent. The most common causes of death were acute inflammatory process (50.7%), followed by hypovolemic shock (43.7%). The incidence of surgical complications was 26.6 per cent. Intra-abdominal abscesses were the most frequent surgical complication (10%). After multiple logistic regression analysis, increasing age and a numerically greater initial base deficit were found to be independent predictors of mortality in trauma patients that require TAC.     

Tactics and technic of abdominal closure in relaparotomy, abdominal dehiscence and peritonitis

In cases of reexploration, abdominal wound dehiscence, and peritonitis closure of the abdomen calls for a flexible technique which can be adapted to local circumstances. Skin and the subcutaneous layer should be left open if contaminated from within the abdomen. If multi-layer closure becomes difficult, one should resort to one-layer closure sparing skin and subcutis. If approximation of wound edges becomes difficult or impossible, open stabilization of the abdomen is advocated, a simple method, applicable everywhere with an acceptable risk.     

Vacuum-assisted fascial closure for patients with abdominal trauma

BACKGROUND: Massive fluid resuscitation often is required for patients with intraabdominal trauma. Subsequently, fascial closure is not always possible in this subset of patients. Under these circumstances, an initial step can be the use of a temporary abdominal closure method. The authors currently use a vacuum-assisted closure to manage the open abdomen for some of their trauma patients. They present their experience over the past 3 years. METHODS: From January 2000 to December 2002, 48 trauma patients were treated with temporary abdominal closure using a vacuum-assisted dressing. The ultimate management of the abdominal defect, the serum lactate levels measured in the emergency department, and the fluid balance at the last attempt to accomplish fascial closure were reviewed. RESULTS: Delayed fascial closure was achieved in 23 (71.9%) of 32 patients who survived to discharge (26 of 48, 54.2%). Of the 32 patients who survived to discharge, 9 (28.1%) required an alternative closure, most often a split-thickness skin graft. Of the 16 patients who died before discharge, 8 died within 24 hours after admission. Whereas 5 of the 16 deaths occurred after delayed abdominal closure, 11 patients died without abdominal closure. Emergency department serum lactate levels above 8 mg/dL show a positive correlation with in-hospital mortality (6 of 16 patients; 38%; p = 0.001) and mortality within 24 hours of admission (6 of 8 patients; 75%; p = 0.003). Admission lactate levels were not associated with the type of closure achieved. However, primary closure was associated with a significant decrease in lactate levels during the first 12 hours. Complications included five abdominal abscesses, two enterocutaneous fistulas, and one split-thickness skin graft failure. CONCLUSIONS: Patients requiring temporary abdominal closure have a significant in-hospital mortality rate of 33%. Delayed primary closure with vacuum assistance was achieved for 71.9% of the surviving patients. Maintaining a negative or total positive fluid balance of less than 20 L before the last attempted fascial closure improves successful closure rates, as seen in 19 of 22 patients (86.4%). The vacuum-assisted closure technique also enabled successful primary closure for two patients with extreme delay (>8 days). Elevated serum lactate levels are significantly correlated with early and in-hospital mortality. A significant decrease in lactate level during the first 12 hours is associated with achievement of primary closure.     

Modified Chevrel technique for abdominal closure in critically ill patients with abdominal hypertension and limited options for closure

Hernia - Abdominal compartment syndrome is a potentially life-threatening condition seen in critically ill patients, and most often caused by acute pancreatitis, postoperative abdominal vascular...     

Modern approaches to the problem of temporary closure of the abdominal cavity

The literature data are adduced concerning the problem of the abdominal cavity temporary closure after performance of operative intervention in the enhanced intraabdominal pressure conditions, in particular in patients with diffuse peritonitis, extended abdominal wall defect, abdominal trauma and intestinal ischemia. Retrospective analysis of the treatment results was conducted in 35 patients with peritonitis and abdominal trauma, in whom the laparostomy method was applied in the clinic. The operations for the abdominal wall restoration or the operative wound edges approximation were performed under the intraabdominal pressure control. Application of the method of the abdominal cavity temporary closure in the treatment of severe forms of peritonitis have promoted the complications rate lowering, the treatment duration reduction and the patients quality of life improvement.