Making a virtue of necessity: managing the open abdomen

BACKGROUND: The open abdomen, or laparostomy, is becoming increasingly used in the management of critically ill surgical patients. METHODS: The published work on laparostomy is reviewed, in the light of personal experience, with particular attention to the history and pathophysiology associated with laparostomy. RESULTS AND CONCLUSION: The combination of an inert plastic sheet in contact with the viscera, and the application of subatmospheric pressure on the wound, is an effective combination to maximize the prospects of delayed primary wound closure while minimizing the chance of fistula and ventral hernia.