title: Comparison of early surgical alternatives in the management of open abdomen: a randomized controlled study.
abstract: BACKGROUND
  Abdominal compartment syndrome (ACS) is a clinical syndrome characterized by progressive intraabdominal organ dysfunction resulting from an acute increase in intra-abdominal pressure (IAP). In the absence of prompt treatment, ACS can lead to lethal organ failure. Treatment of ACS is achieved by immediate decompression of the abdominal cavity. As to how and when decompression laparotomy should be performed depends on the clinical condition of the patients. There is limited data regarding outcomes of abdominal closure techiques. The present study aimed to investigate two different temporary closure methods, the vacuum assisted closure (VAC) and Bogota bag techniques, in 40 patients who underwent decompressive laparotomy as part of the management of ACS.
  
  
  METHODS
  The study included 40 patients who developed ACS during follow-up or following trauma and abdominal surgery. As part of the treatment for ACS, these patients underwent decompressive laparotomy at the Cukurova University Medical Faculty, General Surgery Department and followed up in the Intensive Care Unit of the same hospital. VAC and Bogota bag procedures were performed as temporary closure methods for the treatment of ACS. Patients were randomly assigned to each of the two groups according to the temporary closure method performed. Clinical, laboratory, mortality and morbidity results of the patients in both groups were compared.
  
  
  RESULTS
  Demographic features of the patients (age, sex, body mass index, co-morbidities) were similar between the two groups. The most common reason of ACS was gastrointestinal perforation in 12 (30%) patients. Decrease in incision width was significantly faster in the VAC group than in the Bogota group. Primary closure of fascia was considered appropriate in 16.9 days in the VAC group and 20.5 days in the Bogota bag group. The decrease in abdominal pressure was similar between the two groups on days 1, 4 and 7 but appeared to be significantly lower on day 14 in the VAC group. 12 patients (30%) died during the study. Among the deceased patients, 5 (12%) were in the VAC group, whereas, 7 (17.5%) belonged to the Bogota bag group.
  
  
  CONCLUSIONS
  Based on these results, it is suggested that VAC has advantages when compared to the Bogota bag as a temporary closure method in the management of abdominal compartment syndrome.
authors.affiliation: Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey. rncz1980@gmail.com.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Rencüzoğulları
authors.affiliation: Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey.
authors.forename: Kubilay
authors.initials: K
authors.lastname: Dalcı
authors.affiliation: Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey.
authors.forename: İsmail Cem
authors.initials: İC
authors.lastname: Eray
authors.affiliation: Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey.
authors.forename: Orçun
authors.initials: O
authors.lastname: Yalav
authors.affiliation: Department of General Surgery, Ankara University Faculty of Medicine, Ankara, Turkey.
authors.forename: Alexis Kofi
authors.initials: AK
authors.lastname: Okoh
authors.affiliation: Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey.
authors.forename: Tolga
authors.initials: T
authors.lastname: Akcam
authors.affiliation: Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Ülkü
authors.affiliation: Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey.
authors.forename: Gürhan
authors.initials: G
authors.lastname: Sakman
authors.affiliation: Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey.
authors.forename: Cem P
authors.initials: CP
authors.lastname: Parsak
mesh_terms: D034841:Abdominal Cavity / Q000601:surgery*; D000007:Abdominal Injuries / Q000601:surgery*; D003161:Compartment Syndromes / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods; D011183:Postoperative Complications; D016896:Treatment Outcome