Abdominal content containment: practicalities and outcome.
BACKGROUND
Alternatives to fascial closure of the abdominal wall are increasingly used in critically ill patients. They pose practical and logistical problems in management which are described in this single-institution study.


METHODS
Between January 1994 and December 1997, 157 predominantly young male patients (100 trauma and 57 non-trauma) underwent temporary abdominal content containment (t-ACC) using plastic bags or polyglactin mesh. Indications for t-ACC were severe sepsis requiring reoperation, abdominal compartment syndrome, abdominal wall tissue loss or a combination of these. A total of 385 laparotomies were performed.


RESULTS
Two t-ACC procedures failed owing to technical error and two were complicated by enteric fistulas. Six patients underwent early definitive abdominal closure within 15 days. The remaining survivors had a protracted hospital stay (mean(s.d.) 44.6(26.6) days) and all developed incisional hernias which were challenging to repair. The overall mortality rate was 44 per cent.


CONCLUSIONS
Plastic bags were cheaper and as effective as polyglactin mesh for t-ACC. Survivors require a multidisciplinary approach in management, undergo a protracted hospital stay and later need complex incisional hernia repairs.
Ghimenton
F
F
Department of Surgery and Anaesthesia, University of Natal, Durban, South Africa.
Thomson
S R
SR
Muckart
D J
DJ
Burrows
R
R
D000007:Abdominal Injuries / Q000601:surgery; D000009:Abdominal Muscles / Q000601:surgery*; D001012:Aorta, Abdominal; D001018:Aortic Diseases / Q000601:surgery; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery; D008297:Male; D010538:Peritonitis / Q000601:surgery; D010969:Plastics / Q000627:therapeutic use*; D011098:Polyglactin 910 / Q000627:therapeutic use*; D011446:Prospective Studies; D013524:Surgical Flaps; D013526:Surgical Mesh; D016896:Treatment Outcome
D010969:Plastics; D011098:Polyglactin 910