Management of the open abdomen

Primary closure of the abdomen following laparotomy is not always feasible or desirable. With the evolution of the damage control laparotomy, a better understanding of intra-abdominal hypertension (IAH), as well as advances in surgical critical care, more abdomens are being left open. Retrospective studies have shown a marked improvement in the overall survival of these patients; however this has been paralleled by an increase in morbidities specific to this pathologic state. Temporary abdominal closure (TAC) systems have been designed to minimize these complications and facilitate serial abdominal closure (SAC) as an alternative to the traditional creation of a planned ventral hernia (VH). A review of the literature supports our contention that early definitive closure of the abdomen, if possible, is superior to the historic approach. Earlier recognition of IAH, a greater appreciation of the pathophysiologic alterations inherent to the open abdomen, and innovative modifications of the currently available TAC systems will allow surgeons to better treat this dramatic and potentially devastating injury.