Intra-abdominal pressure: a reliable criterion for laparostomy closure?
BACKGROUND
Laparostomy is frequently performed in the surgical therapy of mechanical obstruction, peritonitis, or trauma to prevent abdominal compartment syndrome (ACS). Extended incisional hernia is inevitable when fascial closure is missed (up to 90% of cases). Intra-abdominal pressure (IAP) has not yet been evaluated as a criterion for the feasibility of fascial closure.


METHODS
Over 12 months laparostomy was carried out in 40 patients. Definitive closure of the abdomen was performed after 4.4+/-3.7 days in 23 of these. Intravesical pressure was used to assess IAP before and after fascial closure. The resulting IAP was compared to the values of 90 patients undergoing elective abdominal surgery. Parameters of cardiocirculatory, renal, pulmonary, and liver function were also recorded.


RESULTS
After closure of the laparostomy IAP increased significantly from 6.5+/-3.3 to 12.0+/-4.1 mmHg. Urine output decreased by 27% on the first postoperative day but regained normal levels thereafter. The central venous pressure increased by 31%. Other parameters of cardiocirculatory, renal, pulmonary, and liver function were unchanged. No case of ACS occurred. In the patients undergoing elective abdominal surgery IAP ranged from 6.5+/-2.1 to 10.0+/-4.0 mmHg.


CONCLUSIONS
Fascial closure increased the IAP, which was accompanied by short-termed decrease in urine output. At these levels of IAP fascial closure appears to be harmless, but further prospective studies are needed to determine the critical level of IAP for allowing a safe repair of large fascial defects.
Schachtrupp
A
A
Department of Surgery, Rhenish Westphalian Technical University, Pauwelsstrasse 30, 52074 Aachen, Germany. Alexander.Schachtrupp@post.rwth-aachen.de
Höer
J
J
Töns
C
C
Klinge
U
U
Reckord
U
U
Schumpelick
V
V
D034841:Abdominal Cavity / Q000503:physiopathology*; D003161:Compartment Syndromes / Q000209:etiology; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008365:Manometry / Q000295:instrumentation; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D019990:Perioperative Care; D011183:Postoperative Complications; D011312:Pressure / Q000009:adverse effects; D013536:Suture Techniques / Q000009:adverse effects; D013997:Time Factors; D001743:Urinary Bladder / Q000503:physiopathology; D014546:Urinary Catheterization / Q000295:instrumentation; D014556:Urine / Q000502:physiology