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Federico Coccolini - Open Abdomen: A Comprehensive Practical Manual

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Federico Coccolini Open Abdomen: A Comprehensive Practical Manual

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This book is the first available practical manual on the open abdomen. Practicing physicians, surgeons, anesthesiologists, nurses, and physiotherapists will find in it a ready source of information on all aspects of open abdomen management in a wide variety of settings. The coverage includes, for example, the open abdomen in trauma, intra-abdominal sepsis, and acute pancreatitis, step-by-step descriptions of different techniques with the aid of high-quality color figures, guidance on potential complications and their management, and features of management in different age groups. The book contents illustrate the most recent innovations and drawing upon a thorough and up-to-date literature review. Useful tips and tricks are highlighted, and the book is designed to support in daily decision making. The authors include worldwide opinion leaders in the field, guaranteeing the high scientific value of the content.

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Springer International Publishing AG, part of Springer Nature 2018
Federico Coccolini , Rao Ivatury , Michael Sugrue and Luca Ansaloni (eds.) Open Abdomen Hot Topics in Acute Care Surgery and Trauma
1. Open Abdomen: Historical Notes
Rao R. Ivatury 1
(1)
Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
Rao R. Ivatury
Email:
The story of open abdomen management (OAM) is reminiscent of many other advances in medicine: described, forgotten, reinvented, ridiculed, and finally accepted. The science of OAM continues to unfold and presents us with a fascinating glimpse into the mysteries of pressureperfusion phenomena, cytokine response to injury and sepsis, the splanchnic bed, and its role as the motor for multiorgan failure, just to name a few. It is a rational surgical approach, based on solid physiologic principles. Many of the details of OAM management will be discussed in detail in other parts of this work. This chapter will present the evolutionary history of OAM from its origin to the current state.
OAM may very well be an apt example of the oft-quoted adage: There is very little new under the sun. All the way back in 1940, Sir Heneage Ogilvie already devised the use of a double sheet of light canvas or stout cotton cut rather smaller than the defect in the muscles, and sutured into place with interrupted catgut sutures for temporary closure of abdominal war wounds when there was too much tension to close primarily []. He described it as akin to draining an abscess by open drainage.
This great innovation, though well described, was soon forgotten for another 40 years. Tables ] published the first large experience with small bowel perforation complicating the open treatment of generalized peritonitis and suggested that the open abdomen itself is a risk factor for this complication.
Table 1.1
Literature reports of the first 50 years of open abdomen (19401990) for abdominal sepsis
Author, year
Indication for OAM
Results
Comments
Ogilvie, 1940
Temporary closure of abdominal war wounds with too much tension to close primarily
Double sheet of light canvas or stout cotton cut rather smaller than the defect in the muscles and sutured into place with interrupted catgut sutures Vaseline-impregnated gauze rolls over exposed viscera and closure of wound over them with strips of Elastoplast or stitches
Ogilvie, 1945
Leave the abdomen open and close it secondarily after 14 days
Steinberg, 1979
Fourteen patients with acute generalized peritonitis, the abdomen was left open after the first laparotomy by gauze packs on the viscera. Abdominal wires were placed to be tied to close the abdomen after 4872 h
Mortality 7%
Treat the infected abdomen just as an abscess
Duff and Moffat, 1981
Abdominal sepsis, necrotizing wound infection
39% mortality
Abdominal closure by STSG/skin sutures
Mughal, 1986
Fourteen patients: GI perforations/anastomotic dehiscence (n-11), recurrent pancreatic abscess ( n = 3)
28% mortality
OAM termed laparostomy
Hedderich, 1986
Ten patients with abdominal sepsis and fecal peritonitis (3), radiation enteritis with fistula (1), diverticular abscess (1), diffuse post-op sepsis (2), necrotizing pancreatitis (3)
20% mortality
Marlex mesh with zipper
Schein, 1988
Nine with diffuse peritonitis
32% mortality
Average seven reoperations per patient!
Mastboom, 1989
Fourteen with 53 small bowel fistulas from OAM
64% mortality
A detailed description of this dreadful complication after OAM
Garcia-Sabrido, 1989
Forty-nine with necrotic pancreatitis
Fifteen with severe intra-abdominal sepsis
Intra-abdominal sepsis: (in 26.5%) mortality (expected 45%), pancreatic necrosis (6%, single abscess, 9, 22% infected pancreatic necrosis (expected 47%)
Quantification of severity of illness by APACHE II
Ivatury, 1989
Thirty patients with abdominal sepsis (11 patients after trauma [group 1], 5 pancreatic abscess [group 2], 14 acute GI pathology [group 3])
Mortality 27% in group 1, 40% in group 2, and 64% in group 3
Survival: age < 50 years and the absence of multiple organ failure
Quantification of severity of illness by APACHE II
Absorbable mesh for TAC
Ivatury, 1990
13 with post-trauma abdominal sepsis, 11 with MOF
Mortality 23%
APACHE II scoring, absorbable mesh for TAC
Whitmann, 1990
One hundred and seventeen treated by Etappen lavage
APACHE II scoring
Actual mortality 25% (expected mortality 47%)
TAC retention sutures ( n = 45), a simple zipper ( n = 26), a slide fastener ( n = 29), and Velcro analogue ( n = 17)
Christou, 1993
Two hundred and thirty-nine patients with surgical abdominal infection in a prospective, open, consecutive, nonrandomized trial
Closed abdomen technique: 31% mortality versus 44% open abdomen
Surgical Infection Society study
Table 1.2
Literature reports, 19902000, on damage control surgery (DCS) for trauma
Author, year
Indication for OAM
Comments
Burch, 1992
Abbreviated laparotomy
Multiple towel clip closure of abdominal incision, not truly an OAM technique
Morris, 1993
Staged celiotomy for trauma
Rapid closure of the abdomen in phase 1. Decompressive laparotomy for ACS. Not truly an OAM technique. ACS is diagnosed when fully developed
Rotondo, 1993
Damage control (DC): first use and description of term
Rapid closure of the abdomen. Not truly an OAM technique, no mention of IAP measurement
Meldrum, 1997
Twenty-one (14%) of 145 patients (ISS > 15) requiring laparotomy developed ACS; 24% were planned decompression. The remaining were prompted by deteriorating organ function from ACS
Not truly an OAM technique. ACS is diagnosed only when fully developed
Proposed ACS grading system for selective management of the syndrome
Ivatury, 1997
State-of-the-art review article
Emphasis on IAP measurement, IAH as a precursor of ACS, surgical intervention at the stage of IAH and not wait until full-blown ACS
Among the first to propose non-closure of fascia, OAM with fascial prosthesis as prophylaxis for IAH in high-risk patients
Mayberry, 1997
Group 1 consisted of 47 patients who received mesh at initial celiotomy, and group 2, 26 patients who received mesh at a subsequent celiotomy. Groups were statistically similar in demographics, injury severity, and mortality. Group 2 had a significantly higher incidence of postoperative abdominal compartment syndrome (35 versus 0%), necrotizing fasciitis (39 versus 0%), intra-abdominal abscess/peritonitis (35 versus 4%), and enterocutaneous fistula (23 versus 11%) compared with group 1 ( p < 0.001)
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