title: Abdominal closure using nonabsorbable mesh after massive resuscitation prevents abdominal compartment syndrome and gastrointestinal fistula.
abstract: Patients who receive high-volume resuscitation after massive abdominopelvic trauma, or emergent repair of a ruptured abdominal aortic aneurysm (RAAA), are at a significant risk for postoperative abdominal compartment syndrome (ACS). Absorbable prosthetic closure of the abdominal wall has been recommended as a means of managing ACS. However, use of absorbable prosthetic has been associated with very high rates of intestinal fistula formation and ventral hernia formation. The purpose of this study was to retrospectively review our experience with the use of nonabsorbable prosthetic abdominal closures in patients with documented ACS or at high risk for ACS. All patients managed by this technique from July 1995 through July 1997 after repair of ruptured abdominal aortic aneurysm or massive abdominopelvic trauma were evaluated. A total of 18 patients were identified: 15 primary prosthetic placements (Gore-Tex patch, 12; Marlex mesh, 2; and silastic mesh, 1) and 3 delayed prosthetic placements for ACS (Gore-Tex, 1 and Marlex, 2). The mortality rate was 22 percent (4 of 18) and resulted from multisystem organ failure (2 patients), cardiac arrest 1 hour postoperatively (1 patient), and severe closed head injury (1 patient). Secondary closure and prosthetic removal was possible in 16 of 18 patients, including the 2 patients who died of multisystem organ failure within the same hospitalization. Delayed abdominal closure at a subsequent admission was performed in two cases. This same patient developed an enterocutaneous fistula 2 months after discharge. Importantly, only 1 of 18 closed in this manner developed ACS requiring reoperation. The results indicate that use of a nonabsorbable prosthetic, particularly with Gore-Tex, is efficacious in the prevention of postoperative ACS in high-risk patients, while it enhances the possibility for delayed abdominal closure and minimizes the risk of gastrointestinal fistulization associated with other techniques.
authors.affiliation: Division of Trauma, Spectrum Health Downtown Campus, Grand Rapids, Michigan, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Ciresi
authors.forename: R F
authors.initials: RF
authors.lastname: Cali
authors.forename: A J
authors.initials: AJ
authors.lastname: Senagore
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000601:surgery*; D001019:Aortic Rupture / Q000150:complications / Q000601:surgery*; D001672:Biocompatible Materials; D003161:Compartment Syndromes / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005747:Gastric Fistula / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011095:Polyethylenes; D011126:Polypropylenes; D011138:Polytetrafluoroethylene; D012151:Resuscitation / Q000009:adverse effects*; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
chemical_list: D001672:Biocompatible Materials; C016674:Plastipore; D011095:Polyethylenes; D011126:Polypropylenes; D011138:Polytetrafluoroethylene