Non-traumatic causes and the management of the open abdomen.

The open abdomen is increasingly used for the treatment and prevention of abdominal compartment syndrome. The leading non-traumatic conditions that may cause abdominal compartment syndrome requiring surgical decompression include secondary peritonitis, ruptured abdominal aortic aneurysm and severe acute pancreatitis. Patients may also end up with the open abdomen when the laparotomy wound cannot be closed without tension because of excessive visceral swelling. Also, surgical complications such as laparotomy wound dehiscence, may require temporary abdominal closure techniques. In critically ill surgical patients and in situations when second-look laparotomy is mandatory the open abdomen can be utilized in a preventive manner like in damage control trauma surgery. Underlying disease and the indication for the open abdomen significantly contributes to outcome of patient with open abdomen. Non-traumatic aetiology of the open abdomen is associated with lower likelihood of primary fascial closure and higher rate of open abdomen related complications compared with traumatic aetiology. A number of temporal abdominal closure techniques have been described. Ideally, temporal abdominal closure technique should prevent the development of recurrent abdominal compartment syndrome and facilitate later primary fascia closure with low complication rate. Although fascial closure rate varies between techniques, there are few evidence-based data to support one technique over another. However, recent evolution of temporary abdominal closure techniques have decreased the number of patients with frozen abdomen and reduced the need for planned hernia management. Highest fascial closure rates have been achieved with vacuum-assisted closure systems and systems that provide continuous fascial traction.