RESUMEN
BACKGROUND: Maintaining normal intra-abdominal pressure (IAP) levels must be one major outcome of any ventral hernia repair, avoiding hypertension or abdominal compartment syndrome. AIMS: To evaluate IAP during ventral hernia repair using Lázaro da Silva's procedure. METHODS: IAP measurements using intravesical pressure were performed during four crucial intraoperative moments. Twenty-eight patients submitted to incisional herniorrhaphy were analyzed. RESULTS: The IAP increased by 0.5 mmHg during the procedure, regardless of the type of prior laparotomy, sex, age, obesity, or hernia width. CONCLUSIONS: Despite the IAP increase observed, Lázaro da Silva's procedure did not result in intra-abdominal hypertension or abdominal compartment syndrome.
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Hernia Ventral , Herniorrafia , Hipertensión Intraabdominal , Humanos , Estudios Transversales , Femenino , Hernia Ventral/cirugía , Masculino , Persona de Mediana Edad , Herniorrafia/métodos , Hipertensión Intraabdominal/cirugía , Hipertensión Intraabdominal/fisiopatología , Anciano , Adulto , Monitoreo Intraoperatorio/métodos , Presión , Anciano de 80 o más AñosRESUMEN
Traditional surgical treatment of widespread purulent peritonitis has some disadvantages that emphasizes the need for new approaches to postoperative care. The authors present successful treatment of diffuse purulent peritonitis using a combination of 'open abdomen' technology and VAC therapy. This approach reduces abdominal inflammation and intra-abdominal pressure. Combination of 'open abdomen' technology and VAC therapy provides effective control of inflammation and stabilization of patients with purulent peritonitis.
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Hipertensión Intraabdominal , Terapia de Presión Negativa para Heridas , Peritonitis , Humanos , Peritonitis/etiología , Peritonitis/cirugía , Peritonitis/diagnóstico , Hipertensión Intraabdominal/etiología , Hipertensión Intraabdominal/diagnóstico , Hipertensión Intraabdominal/cirugía , Resultado del Tratamiento , Terapia de Presión Negativa para Heridas/métodos , Masculino , Femenino , Persona de Mediana Edad , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: Open abdomen therapy (OAT) is commonly used to prevent or treat abdominal compartment syndrome (ACS) in patients with ruptured abdominal aortic aneurysms (rAAAs). This study aimed to evaluate the incidence, treatment, and outcomes of OAT after rAAA from 2006 to 2021. Investigating data on resuscitation fluid, weight gain, and cumulative fluid balance could provide a more systematic approach to determining the timing of safe abdominal closure. METHODS: This was a single centre observational cohort study. The study included all patients treated for rAAA followed by OAT from October 2006 to December 2021. RESULTS: Seventy-two of the 244 patients who underwent surgery for rAAA received OAT. The mean age was 72 ± 7.85 years, and most were male (n = 61, 85%). The most frequent comorbidities were cardiac disease (n = 31, 43%) and hypertension (n = 31, 43%). Fifty-two patients (72%) received prophylactic OAT, and 20 received OAT for ACS (28%). There was a 25% mortality rate in the prophylactic OAT group compared with the 50% mortality in those who received OAT for ACS (p = .042). The 58 (81%) patients who survived until closure had a median of 12 (interquartile range [IQR] 9, 16.5) days of OAT and 5 (IQR 4, 7) dressing changes. There was one case of colocutaneous fistula and two cases of graft infection. All 58 patients underwent successful abdominal closure, with 55 (95%) undergoing delayed primary closure. In hospital survival was 85%. Treatment trends over time showed the increased use of prophylactic OAT (p ≤ .001) and fewer ACS cases (p = .03) assessed by Fisher's exact test. In multivariable regression analysis fluid overload and weight reduction predicted 26% of variability in time to closure. CONCLUSION: Prophylactic OAT after rAAA can be performed safely, with a high rate of delayed primary closure even after long term treatment.
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Aneurisma de la Aorta Abdominal , Rotura de la Aorta , Hipertensión Intraabdominal , Terapia de Presión Negativa para Heridas , Mallas Quirúrgicas , Humanos , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/mortalidad , Masculino , Anciano , Femenino , Terapia de Presión Negativa para Heridas/efectos adversos , Rotura de la Aorta/cirugía , Rotura de la Aorta/mortalidad , Hipertensión Intraabdominal/etiología , Hipertensión Intraabdominal/prevención & control , Hipertensión Intraabdominal/cirugía , Anciano de 80 o más Años , Resultado del Tratamiento , Estudios Retrospectivos , Tracción/efectos adversos , Tracción/métodos , Factores de Tiempo , Persona de Mediana Edad , Técnicas de Abdomen Abierto/efectos adversos , Factores de Riesgo , Técnicas de Cierre de Herida Abdominal/efectos adversos , Técnicas de Cierre de Herida Abdominal/instrumentación , Fasciotomía/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiologíaRESUMEN
In experimental medicine, a wide variety of sensory measurements are used. One of these is real-time precision pressure measurement. For comparative studies of the complex pathophysiology and surgical management of abdominal compartment syndrome, a multichannel pressure measurement system is essential. An important aspect is that this multichannel pressure measurement system should be able to monitor the pressure conditions in different tissue layers, and compartments, under different settings. We created a 12-channel positive-negative sensor system for simultaneous detection of pressure conditions in the abdominal cavity, the intestines, and the circulatory system. The same pressure sensor was used with different measurement ranges. In this paper, we describe the device and major experiences, advantages, and disadvantages. The sensory systems are capable of real-time, variable frequency sampling and data collection. It is also important to note that the pressure measurement system should be able to measure pressure with high sensitivity, independently of the filling medium (gas, liquid). The multichannel pressure measurement system we developed was well suited for abdominal compartment syndrome experiments and provided data for optimizing the method of negative pressure wound management. The system is also suitable for direct blood pressure measurement, making it appropriate for use in additional experimental surgical models.
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Investigación Biomédica , Hipertensión Intraabdominal , Humanos , Hipertensión Intraabdominal/diagnóstico , Hipertensión Intraabdominal/cirugía , Determinación de la Presión Sanguínea , Cultura , Modelos AnatómicosRESUMEN
BACKGROUND: The open abdomen is an innovation that greatly improved surgical understanding of damage control, temporary abdominal closure, staged abdominal reconstruction, viscera and enteric fistula care, and abdominal wall reconstruction. This article provides an evidence-informed, expert, comprehensive narrative review of the open abdomen in trauma, acute care, and vascular and endovascular surgery. METHODS: A group of 12 international trauma, acute care, and vascular and endovascular surgery experts were invited to review current literature and important concepts surrounding the open abdomen. RESULTS: The open abdomen may be classified using validated systems developed by a working group in 2009 and modified by the World Society of the Abdominal Compartment Syndrome-The Abdominal Compartment Society in 2013. It may be indicated in major trauma, intra-abdominal sepsis, vascular surgical emergencies, and severe acute pancreatitis; to facilitate second look laparotomy or avoid or treat abdominal compartment syndrome; and when the abdominal wall cannot be safely closed. Temporary abdominal closure and staged abdominal reconstruction methods include a mesh/sheet, transabdominal wall dynamic fascial traction, negative pressure wound therapy, and hybrid negative pressure wound therapy and dynamic fascial traction. This last method likely has the highest primary fascial closure rates. Direct peritoneal resuscitation is currently an experimental strategy developed to improve primary fascial closure rates and reduce complications in those with an open abdomen. Primary fascial closure rates may be improved by early return to the operating room; limiting use of crystalloid fluids during the surgical interval; and preventing and/or treating intra-abdominal hypertension, enteric fistulae, and intra-abdominal collections after surgery. The majority of failures of primary fascial closure and enteroatmospheric fistula formation may be prevented using effective temporary abdominal closure techniques, providing appropriate resuscitation fluids and nutritional support, and closing the abdomen as early as possible. CONCLUSION: Subsequent stages of the innovation of the open abdomen will likely involve the design and conduct of prospective studies to evaluate appropriate indications for its use and effectiveness and safety of the above components of open abdomen management.
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Fístula , Hipertensión Intraabdominal , Pancreatitis , Humanos , Enfermedad Aguda , Hipertensión Intraabdominal/cirugía , Estudios Prospectivos , PeritoneoRESUMEN
BACKGROUND: Intra-abdominal hypertension (IAH) is a classical complication after giant ventral hernia surgery and may lead to abdominal compartment syndrome (ACS). Assessment of risk factors and prevention of IAH/ACS are essential for hernia surgeons. METHODS: We performed a retrospective study including 58 giant ventral hernia patients in our center between Jan 1, 2017, and Mar 1, 2022, we recorded age, gender, chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), hypertension, type 2 diabetes mellitus (T2DM), hypoproteinemia, body mass index (BMI), the ratio of hernia sac volume to abdominal cavity volume (HSV/ACV), defect width, tension reduction procedure (TRP), positive fluid balance (PFB) and IAH of these patients and analyzed the data using univariate and multivariate logistic regression to screen the risk factors for IAH after surgery. RESULTS: The multivariate analysis showed that HSV/ACV ≥ 25%, hypoproteinemia, and PFB were independent risk factors for the occurrence of IAH after giant ventral hernia repair (P = 0.025, 0.016, 0.017, respectively). We did not find any correlation between postoperative IAH and the patient's age, gender, COPD, CHD, hypertension, T2DM, BMI, defect width, TRP, and PFB. CONCLUSION: Identifying risk factors is of great significance for the early identification and prevention of IAH/ACS. We found that HSV/ACV ≥ 25%, hypoproteinemia, and PFB were independent risk factors for IAH after giant ventral hernia repair.
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Diabetes Mellitus Tipo 2 , Hernia Ventral , Hipertensión , Hipoproteinemia , Hipertensión Intraabdominal , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Hipertensión Intraabdominal/cirugía , Estudios Retrospectivos , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/cirugía , Modelos Logísticos , Herniorrafia/métodos , Hernia Ventral/cirugía , Factores de Riesgo , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/cirugía , Hipoproteinemia/complicaciones , Hipoproteinemia/cirugíaRESUMEN
OBJECTIVE: The aim: To improve the results of treatment of patients diagnosed with acute pancreatitis. PATIENTS AND METHODS: Materials and methods: The materials of the work are based on the clinical examination and treatment of 301 patients with acute pancreatitis, in the treatment of which, along with classical treatment, a therapeutic and diagnostic complex was used, which allows predicting and preventing the development of abdominal compartment syndrome (ACS). RESULTS: Results: Managed to reduce the number of cases of infected pancreatic necrosis, effectively predict and prevent the development of abdominal compartment syndrome (ACS), reduce the average length of stay of patients in the hospital. CONCLUSION: Conclusions: The use of the proposed management algorithm for patients with acute pancreatitis allows to shorten the treatment period by effectively predicting and preventing the development of pancreatic necrosis, its septic complications and abdominal compartment syndrome.
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Hipertensión Intraabdominal , Pancreatitis Aguda Necrotizante , Humanos , Hipertensión Intraabdominal/etiología , Hipertensión Intraabdominal/cirugía , Pancreatitis Aguda Necrotizante/terapia , Pancreatitis Aguda Necrotizante/cirugía , Enfermedad Aguda , Laparotomía/efectos adversosRESUMEN
Pneumoperitoneum is the presence of free air within the peritoneal cavity and indicates perforation of a hollow viscus. However, it may also occur in the absence of perforation and in this case, it is called spontaneous pneumoperitoneum (SP). A 57-year-old female patient who was intubated and mechanically ventilated due to respiratory failure developed abdominal compartment syndrome (ACS) secondary to massive SP. Peritoneal lavage was performed for the patient both to achieve decompression and to support the diagnosis. Many surgeons proceed with laparotomy as a reflex response for SP due to lack of awareness of the condition. However, laparotomy has no place in this setting. SP coexisting with ACS is extremely rare. With this case report, we aimed to raise awareness of SP among physicians and help avoid unnecessary laparotomies.
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Hipertensión Intraabdominal , Neumoperitoneo , Descompresión/efectos adversos , Femenino , Humanos , Hipertensión Intraabdominal/etiología , Hipertensión Intraabdominal/cirugía , Laparotomía/efectos adversos , Persona de Mediana Edad , Lavado Peritoneal/efectos adversos , Neumoperitoneo/diagnóstico por imagen , Neumoperitoneo/etiología , Neumoperitoneo/cirugíaRESUMEN
BACKGROUND: Abdominal compartment syndrome (ACoS) is a devastating complication after endovascular aneurysm repair for ruptured abdominal aortic aneurysms (rEVAR). This study sought to develop a risk score for ACoS to identify patients who would benefit from early decompressive laparotomy. METHODS: Model derivation was performed with Vascular Quality Initiative data for rEVAR from 2013 to 2020. The primary outcome was evacuation of abdominal hematoma. A multivariable logistic regression was used to create and validate a scoring system to predict ACoS. The model was validated using institutional data for rEVAR from 1998 to 2019. RESULTS: The derivation cohort included 2,310 patients with rEVAR. Abdominal hematoma evacuation occurred in 265 patients (11.5%). Factors associated with abdominal hematoma evacuation on a multivariable analysis included transfer from an outside hospital, preoperative creatinine ≥1.4 mg/dL, preoperative systolic blood pressure ≤85 mmHg, preoperative altered mental status, ≥3.0 liters intraoperative crystalloid, and ≥4 units of red blood cells transfused intraoperatively. The validation cohort consisted of 67 rEVAR; ACoS occurred in 8 patients (11.9%). The c-statistic was 0.84 in the derivation and 0.87 in the validation cohort, whereas Hosmer-Lemeshow was P = 0.15 in the derivation and 0.84 in the validation cohorts, suggesting good model discrimination and calibration. Points were applied based on ß-coefficients to produce a risk score ranging from -1 to 13. A cutoff of risk score ≥8 resulted in a sensitivity and specificity of 87.5% and 83.1% for detecting patients with ACoS, respectively. ACoS conveyed a significantly higher mortality in both the derivation (ACoS: 49.8% vs. No ACoS: 17.8%; P < 0.001) and validation cohorts (ACoS: 75.0% vs. No ACoS: 15.2%; P < 0.001). CONCLUSIONS: In patients with equivocal signs/symptoms of ACoS, this scoring system can be used to guide surgeons on when to perform decompressive laparotomy prior to leaving the operating room for rEVAR. Patients with a risk score ≥8 would benefit from decompressive laparotomy at index rEVAR.
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Aneurisma de la Aorta Abdominal , Rotura de la Aorta , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Hipertensión Intraabdominal , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/etiología , Aneurisma de la Aorta Abdominal/cirugía , Rotura de la Aorta/diagnóstico por imagen , Rotura de la Aorta/etiología , Rotura de la Aorta/cirugía , Implantación de Prótesis Vascular/efectos adversos , Hematoma/etiología , Humanos , Hipertensión Intraabdominal/diagnóstico , Hipertensión Intraabdominal/etiología , Hipertensión Intraabdominal/cirugía , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
A 41-year-old male farmer was injured in a land mine explosion. After initial resuscitation, the emergency physician coordinated with the hospital and air medical crew for the patient's evacuation. The evacuation was started by a Bell 214C helicopter, and the patient's clinical condition deteriorated during flight with increased abdominal pain and distension, tachycardia, tachypnea, hypotension, and loss of consciousness. Intra-abdominal (vesical) pressure of 23 mm Hg, findings of in-flight bedside ultrasound, and echocardiography indicated intra-abdominal hypertension with abdominal compartment syndrome. The emergency physician started medical management quickly based on the World Society of Abdominal Compartment Syndrome, but after 15 minutes the intra-abdominal pressure was still > 20 mm Hg. Despite the in-flight difficult condition, the risk of vascular or neural damages, and infection, the emergency physician performed a midline decompression laparotomy and, when the intra-abdominal pressure reached about 11 mm Hg, temporarily covered the wound with a Bogota bag. After the patient's intra-abdominal pressure stabilized, permanent abdominal wound repair was performed by the surgeon, and he was discharged from the hospital.
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Traumatismos Abdominales , Hipertensión Intraabdominal , Traumatismo Múltiple , Abdomen/cirugía , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/diagnóstico por imagen , Traumatismos Abdominales/terapia , Adulto , Descompresión Quirúrgica , Humanos , Hipertensión Intraabdominal/cirugía , Hipertensión Intraabdominal/terapia , MasculinoRESUMEN
BACKGROUND/PURPOSE: Decompressive laparotomy and open abdomen for abdominal compartment syndrome have been historically avoided during Extracorporeal Membrane Oxygenation (ECMO) due to seemingly elevated risks of bleeding and infection. Our goal was to evaluate a cohort of pediatric respiratory ECMO patients who underwent decompressive laparotomy with open abdomen at a single institution and to compare these patients to ECMO patients without open abdomen. METHODS: We reviewed all pediatric respiratory ECMO (30 days-18 years) patients treated with decompressive laparotomy with open abdomen at Riley Hospital for Children (1/2000-12/2019) and compared these patients to concurrent respiratory ECMO patients with closed abdomen. We excluded patients with surgical cardiac disease. We assessed demographics, ECMO data, and outcomes and defined significance as p = 0.05. RESULTS: 6 of 81 ECMO patients were treated with decompressive laparotomy and open abdomen. Open and closed abdomen groups had similar age (p = 0.223) and weight (0.286) at cannulation, but the open abdomen group had a higher reliance on vasoactive medications (Vasoactive Inotropic Score, p = 0.040). Open abdomen group survival was similar to closed abdomen patients (66.7%, vs 62.7%, p = 1). Open abdomen patients had lower incidence of ECMO complications (33.3% vs 83.6%, p = 0.014), but the groups had similar bleeding complications (p = 0.412) and PRBC transfusion volume (p = 0.941). CONCLUSION/IMPACT: Pediatric ECMO patients with open abdomen after decompressive laparotomy had similar survival, blood products administered, and complications as those with a closed abdomen. An open abdomen is not a contra-indication to ECMO support in pediatric respiratory patients and should be considered in select patients.
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Cavidad Abdominal , Oxigenación por Membrana Extracorpórea , Hipertensión Intraabdominal , Abdomen , Niño , Oxigenación por Membrana Extracorpórea/efectos adversos , Humanos , Hipertensión Intraabdominal/etiología , Hipertensión Intraabdominal/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: Necrotizing Enterocolitis (NEC) remained a dramatic complication leading to death or neonatal morbidities in preterms. For some, Intra-Abdominal Hypertension (IAH) and Abdominal Compartment Syndrome worsened the multi-organ failure. An open abdomen surgery could be an alternative to conventional surgical treatment to move beyond this stage. OBJECTIVES: To retrospectively describe the clinical course, pre- and post-operative features of preterms suffering from severe NEC with IAH treated by open abdomen surgery and referred to our center from October 2007 to September 2019. Our secondary objective is to identify various risk factors for mortality in this population. METHODS: Data on neonatal, clinical, biological, pre and post-operative features and outcome were collected. Univariate analyses were performed to compare their pre and post-operative features stratifying on outcome. RESULTS: Among 29 included patients, 14 (48%) survived to discharge without short bowel syndrome. Death was associated with an earlier postnatal age at NEC (16.3 ± 9.1 versus 31.3 ± 25.9 days; p = 0.004) and followed a withdrawal of treatment in 60% of cases. Surgery was associated with a significant improvement of respiratory and hemodynamic features (decrease of mean ventilator pressure from 13.1 ± 5.4 to 11.3 ± 4.0 cmH2O, p < 0.001), oxygen requirement (mean FiO2 decreased from 65.0% ± 31.2 to 49.0% ± 24.6, p < 0.001) and inotropic score (from 38.6 ± 70.1 to 29.9 ± 64.3, p < 0.001). In the survival group, pre and post-operative findings exhibited a significant increase of serum lactate concentrations from 2.7 ± 1.6 to 11.0 ± 20.3 mmol/L (p = 0.02) but a similar pH. CONCLUSION: Open abdomen surgery could be considered to rescue preterms with near fatal NEC. IAH and Abdominal Compartment Syndrome in these preterms should be investigated through further studies. LEVEL OF EVIDENCE: Level III.
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Enterocolitis Necrotizante , Enfermedades del Recién Nacido , Hipertensión Intraabdominal , Abdomen , Estudios de Factibilidad , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Hipertensión Intraabdominal/etiología , Hipertensión Intraabdominal/cirugía , Estudios RetrospectivosRESUMEN
AIM: The management of open abdomen with enteroatmospheric fistula is a real nightmare for surgeons; negative pressure with fluid instillation is affordable and effective. After improvement of general conditions, a good strategy for promoting tissue granulation around the fistula could be the application of a matrix wound dressing. MATERIALS AND METHODS: A 45-year-old man was admitted to our Emergency Department for abdominal compartment syndrome following a previous intervention for bowel occlusion; at exploration we found a frozen abdomen that was managed by negative pressure wound therapy with fluid instillation (AbThera device, VAC Instill , 3M+KCI). The condition was complicated by an enteroatmospheric fistula that we managed by negative pressure and fistula diversion according to "Baby Bottle Nipple VAC technique". After improvement of general and local conditions, in order to obtain a faster reepithalization around the stoma, we decided to apply a dermal substitute (Integra Bilayer Wound Matrix, LifeSciences Corporation). RESULTS: We obtained a good reeepithalization and five months after admittance the patient was dismissed in a good health with a stoma bag applied on the fistula. Six month lather bowel continuity was restored. CONCLUSIONS: The role of negative pressure with instillation in the management of open abdomen is defined; it allows to preserve healthy bowel integrity and to improve septic environment control. If an enteroatmospheric fistula is present, the application of a dermal substitute can be a good strategy for promoting tissue granulation around the fistula, thus allowing the application of a stoma bag and a faster regain of the upright position. KEY WORDS: Dermal Substitute, Enteroatmospheric fistula, Negative pressure Wound therapy, Open abdomen.
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Técnicas de Cierre de Herida Abdominal , Fístula Intestinal , Obstrucción Intestinal , Hipertensión Intraabdominal/cirugía , Terapia de Presión Negativa para Heridas , Técnicas de Abdomen Abierto , Abdomen/cirugía , Dermis Acelular , Vendajes , Humanos , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Obstrucción Intestinal/cirugía , Hipertensión Intraabdominal/etiología , Masculino , Persona de Mediana EdadRESUMEN
Abdominal compartment syndrome (ACS) is an infrequently encountered life-threatening disorder characterised by elevated abdominal pressure with evidence of new organ dysfunction. It is rarely reported in paediatrics. We describe an extremely unusual presentation of a 13-year-old boy with long-standing constipation who developed ACS complicated by refractory septic shock and multiorgan failure. He was treated with emergent decompressive laparotomy and supportive critical care. This case highlights the need for early diagnosis and timely management of ACS to improve its outcome.
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Síndromes Compartimentales , Hipertensión Intraabdominal , Adolescente , Niño , Estreñimiento/etiología , Descompresión Quirúrgica , Humanos , Hipertensión Intraabdominal/etiología , Hipertensión Intraabdominal/cirugía , Laparotomía , Masculino , Discapacidad Intelectual Ligada al Cromosoma X , Insuficiencia MultiorgánicaRESUMEN
Abdominal compartment syndrome (ACS), defined by the presence of increased intra-abdominal pressure>20mmHg in association with failure of at least one organ system, is a common and feared complication that may occur in the early phase of severe acute pancreatitis (AP). This complication can lead to patient death in the very short term. The goal of this review is to provide the surgeon and intensivist with objective information to help them in their decision-making. In the early phase of severe AP, it is essential to monitor intra-vesical pressure (iVP) to allow early diagnosis of intra-abdominal hypertension or ACS. The treatment of ACS is both medical and surgical requiring close collaboration between the surgical and resuscitation teams. Medical treatment includes vascular volume repletion, prokinetic agents, effective curarization and percutaneous drainage of large-volume ascites. If uncontrolled respiratory or cardiac failure develops or if maximum medical treatment fails, most teams favor performing an emergency xipho-pubic decompression laparotomy with laparostomy. This procedure follows the principles of abbreviated laparotomy as described for abdominal trauma.
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Síndromes Compartimentales , Hipertensión Intraabdominal , Pancreatitis , Abdomen/cirugía , Enfermedad Aguda , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Descompresión Quirúrgica/métodos , Humanos , Hipertensión Intraabdominal/diagnóstico , Hipertensión Intraabdominal/etiología , Hipertensión Intraabdominal/cirugía , Laparotomía/métodos , Pancreatitis/complicaciones , Pancreatitis/diagnóstico , Pancreatitis/cirugíaRESUMEN
OBJECTIVE: Acute pancreatitis can usually recover after conservative treatment. Five to 10 percent of acute pancreatitis may proceed into peripancreatic fluid collection and necrosis development, called necrotizing pancreatitis (NP), which has a high mortality rate. If it is accompanied by the occurrence of abdominal compartment syndrome (ACS) and does not respond to medical therapy, surgical intervention is indicated. METHODS: We analyzed our experience of surgical intervention strategies for NP patients with medically irreversible ACS from January 1, 2004, to December 31, 2018. RESULTS: Of the 47 NP patients with ACS, mean Ranson score was 6.5, mean Acute Physiology and Chronic Health Evaluation II score was 22.2, and Modified computed tomography severity index score was all 8 or greater. The mean total postoperative hospital length of stay was 80.2 days, of which the mean intensive care unit length of stay was 16.6 days. The overall complication rate was 31.9%. The mortality rate was 8.5%. Among the 47 patients, only fungemia was significantly associated with mortality incidence. CONCLUSIONS: The combination of multiple drainage tube placement, feeding jejunostomy, and ileostomy at the same time were effective surgical intervention strategies for NP patients with ACS, which brought a lower mortality rate.
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Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Hipertensión Intraabdominal/cirugía , Pancreatitis Aguda Necrotizante/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Hipertensión Intraabdominal/etiología , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Pancreatitis Aguda Necrotizante/complicaciones , Estudios RetrospectivosRESUMEN
A premature infant with abdominal compartment syndrome underwent cardiopulmonary arrest before receiving decompressive laparotomy, and the effect of cardiopulmonary resuscitation was poor. The abdomen was punctured with an 18-gauge needle, alleviating the distension and resulting in successful cardiopulmonary resuscitation.
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Paro Cardíaco , Hipertensión Intraabdominal , Abdomen/cirugía , Descompresión , Paro Cardíaco/terapia , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Hipertensión Intraabdominal/cirugíaRESUMEN
The open abdomen (OA) is an established concept for treating severe abdominal diseases. The most frequent reasons for placement of an open abdomen are abdominal sepsis (e.g. from intestinal perforation or anastomotic leakage), severe abdominal organ injury and abdominal compartment syndrome. The pathophysiology is much more complex than the surgeon's eye can see in an OA. The temporary closure of the abdominal wall ensures sufficient drainage of infected ascites, protection of the intestinal loops and conditioning of the abdominal wall in order to be able carry out definitive closure of the abdominal wall at the end of the surgical treatment. Negative peritoneal pressure therapy combined with fascia traction (with or without mesh) is well-established in the management of an open abdomen.
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Pared Abdominal , Técnicas de Cierre de Herida Abdominal , Hipertensión Intraabdominal , Terapia de Presión Negativa para Heridas , Pared Abdominal/cirugía , Humanos , Hipertensión Intraabdominal/cirugía , Laparotomía , Mallas QuirúrgicasRESUMEN
BACKGROUND: Prevalence of abdominal compartment syndrome (ACS) is estimated to be 4%-17% in severely burned patients. Although decompressive laparotomy can be lifesaving for ACS patients, severe complications are associated with this technique, especially in burn populations. This study outlines a new technique of releasing intraabdominal pressure without resorting to decompressive laparotomy. MATERIALS AND METHODS: Ten fresh tissue cadavers were studied; none of whom had had prior abdominal surgery. Using Veress needles, abdomens were insufflated to 30 mm Hg and subsequently connected to arterial pressure transducers. Two techniques were then used to incise fascia. First, large skin flaps were raised from a midline incision (n = 5). Second, small 2 cm cutdowns at the proximal and distal extent of midaxillary, subcostal, and inguinal incisional sites were made, followed by tunneling a subfascial plane using an aortic clamp with fascial incisions made through the grooves of a tunneled vein stripper (n = 5). Pressures were recorded in the sequence of incisions mentioned previously. RESULTS: The open midline flap technique decreased abdominal pressure from a mean pressure of 30 ± 1.8 mm Hg to 6.9 ± 5.0 mm Hg (P < 0.01). The minimally invasive technique decreased intraabdominal pressure from 30 ± 0.9 to 5.8 ± 5.2 mm Hg (P < 0.01). This technique significantly reduced intraabdominal pressure via extraperitoneal component separation and fascial release at the midaxillary, subxiphoid, and inguinal regions. CONCLUSIONS: This technique offers the benefit of reducing the morbidity, mortality, and complications associated with an open abdomen, which may be beneficial in the burn injury population.