The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper.
The open abdomen (OA) procedure is a significant surgical advance, as part of damage control techniques in severe abdominal trauma. Its application can be adapted to the advantage of patients with severe abdominal sepsis, however its precise role in these patients is still not clear. In severe abdominal sepsis the OA may allow early identification and draining of any residual infection, control any persistent source of infection, and remove more effectively infected or cytokine-loaded peritoneal fluid, preventing abdominal compartment syndrome and deferring definitive intervention and anastomosis until the patient is appropriately resuscitated and hemodynamically stable and thus better able to heal. However, the OA may require multiple returns to the operating room and may be associated with significant complications, including enteroatmospheric fistulas, loss of abdominal wall domain and large hernias. Surgeons should be aware of the pathophysiology of severe intra-abdominal sepsis and always keep in mind the option of using open abdomen to be able to use it in the right patient at the right time.
Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100 Macerata, Italy.
Massimo
M
Sartelli
Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
Fikri M
FM
Abu-Zidan
General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Luca
L
Ansaloni
Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Miklosh
M
Bala
Department of Surgery, Hospital San Juan de Dios, La Serena, Chile.
Marcelo A
MA
Beltrán
Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, USA.
Walter L
WL
Biffl
Emergency Surgery Department, Maggiore Parma Hospital, Parma, Italy.
Fausto
F
Catena
Emergency Department, Niguarda Ca' Granda Hospital, Milan, Italy.
Osvaldo
O
Chiara
General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Federico
F
Coccolini
Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego Health Science, San Diego, USA.
Raul
R
Coimbra
Department of Surgery, Tbilisi State Medical University, Kipshidze Central University Hospital, Tbilisi, Georgia.
Zaza
Z
Demetrashvili
Trauma, Emergency Surgery, Surgical Critical Care, University of Southern California, Los Angeles, USA.
Demetrios
D
Demetriades
Shock Trauma Center, University of Maryland School of Medicine, Baltimore, USA.
Jose J
JJ
Diaz
Trauma Surgery Unit, Maggiore Hospital, Bologna, Italy.
Salomone
S
Di Saverio
Division of Trauma Surgery, Hospital de Clinicas, School of Medical Sciences, University of Campinas, Campinas, Brazil.
Gustavo P
GP
Fraga
Department of Surgery Mansoura, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Wagih
W
Ghnnam
Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK.
Ewen A
EA
Griffiths
Department of Surgery Government Medical College and Hospital, Chandigarh, India.
Sanjay
S
Gupta
Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany.
Andreas
A
Hecker
Clinic for Emergency Surgery, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Aleksandar
A
Karamarkovic
Department of Surgery, Edendale Hospital, Pietermaritzburg, Republic of South Africa.
Victor Y
VY
Kong
Department of Visceral, Thorax and Transplant Surgery, University of Innsbruck, Innsbruck, Austria.
Reinhold
R
Kafka-Ritsch
Department of General Surgery, Rambam Health Care Campus, Haifa, Israel.
Yoram
Y
Kluger
Department of Surgery, Trauma Research Institute, University of Arizona, Tucson, AZ USA.
Rifat
R
Latifi
Abdominal Center, University Hospital Meilahti, Helsinki, Finland.
Ari
A
Leppaniemi
Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Jae Gil
JG
Lee
Department of Surgery, University Hospital of the West Indies, Kingston, Jamaica.
Michael
M
McFarlane
Department of Surgery, Post-Graduate Institute of Medical Sciences, Rohtak, India.
Sanjay
S
Marwah
Department of Surgery, University of Florida, Gainesville, FL USA.
Frederick A
FA
Moore
Department of Surgery, Fundación Valle del Lili, Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia.
Carlos A
CA
Ordonez
Division of Emergency and Trauma Surgery, Ribeirão Preto Medical School, Ribeirão Preto, Brazil.
Gerson Alves
GA
Pereira
Department of General and Emergency Surgery, Riga East Clinical University Hospital "Gailezers", Riga, Latvia.
Haralds
H
Plaudis
Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
Vishal G
VG
Shelat
1st Surgical Department of First Faculty of Medicine, General University Hospital, Prague Charles University, Prague, Czech Republic.
Jan
J
Ulrych
Department of Surgery, MOSC Medical College Kolenchery, Cochin, India.
Sanoop K
SK
Zachariah
Department of Surgery, Mayo Clinic, Rochester, MN USA.
Martin D
MD
Zielinski
Centro de investigaciones clínicas, Fundación Valle del Lili, Cali, Colombia.
Maria Paula
MP
Garcia
Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, USA.
Ernest E
EE
Moore