J.Jpn. Surg. Soc.. 120(3): 304-311, 2019

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Feature topic

ABDOMINAL COMPARTMENT SYNDROME AND OPEN ABDOMEN MANAGEMENT

The development of the concept of damage control and improved understanding of the pathophysiology of abdominal compartment syndrome (ACS), defined as a sustained intraabdominal pressure of >20 mmHg associated with new organ dysfunction, has resulted in major advances in the management of both trauma and nontraumatic surgical conditions. Although these new approaches may decrease the mortality rate of patients with severe physiological derangement, they also allow the specific management of open abdomen. Open abdomen is the condition with a defect in the abdominal wall which exposes the abdominal viscera, created intentionally by leaving an abdominal incision open in patients requiring damage control or by opening the abdomen secondary to ACS. Open abdomen leads to fluid and protein losses, enteric fistula, and loss of abdominal domain, and the main objective of temporary abdominal closure is to control and minimize these sequelae. Several techniques for temporary abdominal closure are available, including negative-pressure systems. If primary fascial closure cannot be achieved, the risk of subsequent large ventral hernia is high, which may require functional reconstruction. A novel approach is expected for the functional recovery of critically ill patients.

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