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Open Abdomen
Federico Coccolini
Rao Ivatury
Michael Sugrue
Luca Ansaloni Editors
A Comprehensive Practical Manual
Hot Topics in Acute Care Surgery and Trauma
Hot Topics in Acute Care Surgery
and Trauma
Series Editors
Federico Coccolini
Cesena, Italy
Raul Coimbra
Riverside, USA
Andrew W. Kirkpatrick
Calgary, Canada
Salomone Di Saverio
Cambridge, UK
Editorial Board:
Luca Ansaloni (Cesena, Italy); Zsolt Balogh (Newcastle, Australia); Walt Biffl
(Denver, USA); Fausto Catena (Parma, Italy); Kimberly Davis (New Haven, USA);
Paula Ferrada (Richmond, USA); Gustavo Fraga (Campinas, Brazil); Rao Ivatury
(Richmond, USA); Yoram Kluger (Haifa, Israel); Ari Leppaniemi (Helsinki, Finland);
Ron Maier (Seattle, USA); Ernest E. Moore (Fort Collins, USA); Lena Napolitano
(Ann Arbor, USA); Andrew Peitzman (Pittsburgh, USA); Patrick Rielly (Philadelphia,
USA); Sandro Rizoli (Toronto, Canada); Boris Sakakushev (Plovdiv, Bulgaria);
Massimo Sartelli (Macerata, Italy); Thomas Scalea (Baltimore, USA); David Spain
(Stanford, USA); Philip Stahel (Denver, USA); Michael Sugrue (Letterkenny, Ireland);
George Velmahos (Boston, USA); Dieter Weber (Perth, Australia)
This series covers the most debated issues in acute care and trauma surgery, from
perioperative management to organizational and health policy issues. Since 2011,
the founder members of the World Society of Emergency Surgery’s (WSES) Acute
Care and Trauma Surgeons group, who endorse the series, realized the need to
provide more educational tools for young surgeons in training and for general
physicians and other specialists new to this discipline: WSES is currently developing
a systematic scientific and educational program founded on evidence-based
medicine and objective experience. Covering the complex management of acute
trauma and non-trauma surgical patients, this series makes a significant contribution
to this program and is a valuable resource for both trainees and practitioners in acute
care surgery.
More information about this series at http://www.springer.com/series/15718
Federico Coccolini • Rao Ivatury
Michael Sugrue • Luca Ansaloni
Editors
Open Abdomen
A Comprehensive Practical Manual
Editors
Federico Coccolini
General, Emergency and Trauma Surgery
Department
Bufalini Hospital
Cesena
Italy
Michael Sugrue
Letterkenny General Hospital
Letterkenny, Donegal
Ireland
Rao Ivatury
General Surgery
Virginia Commonvealth University
Richmond, Virginia
USA
Luca Ansaloni
General, Emergency and Trauma Surgery
Department
Bufalini Hospital
Cesena
Italy
ISSN 2520-8284 ISSN 2520-8292 (electronic)
Hot Topics in Acute Care Surgery and Trauma
ISBN 978-3-319-48071-8 ISBN 978-3-319-48072-5 (eBook)
https://doi.org/10.1007/978-3-319-48072-5
Library of Congress Control Number: 2017963388
© Springer International Publishing AG, part of Springer Nature 2018
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recita-
tion, broadcasting, reproduction on microfilms or in any other physical way, and transmission or infor-
mation storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publica-
tion does not imply, even in the absence of a specific statement, that such names are exempt from the
relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims
in published maps and institutional affiliations.
Printed on acid-free paper
This Springer imprint is published by the registered company Springer International Publishing AG
part of Springer Nature
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
v
Since 2011, the founding members of the World Society of Emergency Surgery
(WSES) Acute Care and Trauma Surgeons group, in collaboration with the
American Association for the Surgery of Trauma (AAST), endorse the “Hot Topics
in Acute Care Surgery and Trauma,” realizing the need to provide more educational
tools for young in-training surgeons and for general physicians and other surgical
specialists. These new forthcoming titles have been selected and prepared with this
philosophy in mind. The books will cover the basics of pathophysiology and clinical
management, framed with the reference that recent advances in the science of resus-
citation, surgery, and critical care medicine have the potential to profoundly alter the
epidemiology and subsequent outcomes of severe surgical illnesses and trauma. In
particular, open abdomen requires detailed understanding as to the potential bene-
fits and complications associated with this surgical approach. There exists, implicit
in use of the open abdomen approach, a decision to adopt the damage control para-
digm in the management of the sickest patients. No other management approach has
been so profoundly linked to changes in resuscitation, with recent advances prompt-
ing a reassessment and critique of all previously accepted principles.
Cesena, Italy Federico Coccolini
Riverside, USA Raul Coimbra
Calgary, Canada Andrew W. Kirkpatrick
Cambridge, UK Salomone Di Saverio
Foreword to the Series
vii
Foreword
It is an honor and great pleasure to write a foreword to the book Open Abdomen: A
Comprehensive Practical Manual edited by surgeons and professors Federico
Coccolini, Rao Ivatury, Michael Sugrue, and Luca Ansaloni. Textbooks focusing
on abdominal wall complications and hernia techniques do exist, but it is still a
challenge to treat an open abdomen patient who needs an abdominal wall recon-
struction. In the era of damage control surgery, complex abdominal wall defects
are more common. Most patients have consequences of complex trauma, cancer,
and necrotizing infections, resulting in abdominal catastrophes without an abdomi-
nal wall.
New technologies are coming—vacuum-assisted systems have been used in
different countries; meshes and biological prostheses developed with biomedical
research have changed the options for surgical repair. The approach to treat
patients with open abdomen or complex abdominal wall defect is multidisci-
plinary, and team experience is important to have good results, with less
complications.
This book presents, in its 22 chapters, the multiple aspects of the challenging
open abdomen and abdominal wall reconstruction. It covers the topic from its begin-
ning with historical hints; the anatomy; pathophysiology; indications; management
in infants, children, and adults; nutritional aspects, complications; definitive clo-
sure; the use of biological prostheses; and quality of life. The editors were very
competent in bringing together a select group of surgeons and teachers who present
the subjects in an objective and practical way, facilitating the learning of the
readers.
viii
There is an old aphorism in medicine that says “the surgeon should not be the
first to adopt a new technique and not be the last to abandon an old technique.” This
manual exhaustively describes when “to leave open and when to close” an abdo-
men. These two key issues are analyzed based on the latest evidence in literature,
with the support of a strong tool: the WSES Guidelines recently published. This
book brings content in the right dose, helping the next generation of surgeons to
properly treat their patients, and it is a gift to the readers and even more to their
patients who will benefit from a more appropriate treatment.
Campinas, SP, Brazil G. P. Fraga
Parma, Italy F. Catena
Foreword
ix
The treatment of patients with intra-abdominal catastrophes with an open abdomen
involves several potential complex management strategies. The open abdomen is
universally recognized as an option to improve outcomes in selected patients. Firstly
described in damage control procedures in trauma the open abdomen is now increas-
ingly used in nontrauma patients. The challenge and key in decision making is bal-
ancing whether an open abdomen is going to benefit patients yet not create
counter-product morbidity. This book explores indications for an open abdomen
and offers practical tricks and techniques to minimize the side effects.
The key to the open abdomen is to allow the patient’s physiology to return to
normal. Comprehending the pathophysiological mechanisms behind its application
is essential and explained in the book. The manual presents different points of view
from the clinicians involved in the management of the open abdomen patients. It
explores care from the very beginning of the treatment through to rehabilitation.
This will help the reader integrate the best information into their practice, from
recognized experts in their respective fields.
We would like to thank all the authors for sharing their precious experience and
hope it will enhance your patient’s outcome.
Cesena, FC, Italy Federico Coccolini
Richmond, VA, USA Rao Ivatury
Letterkenny, Ireland Michael Sugrue
Cesena, Italy Luca Ansaloni
Preface
xi
1 Open Abdomen: Historical Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Rao R. Ivatury
2 Basic Research in Open Abdomen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Paola Fugazzola, Giulia Montori, Sandro Rizoli, Luca Ansaloni,
Joao Rezende-Neto, and Federico Coccolini
3 Anatomy and Physiology of the Abdominal Compartment . . . . . . . . . 35
Manu L.N.G. Malbrain, Brecht De Tavernier, and Pieter- Jan Van Gaal
4 The Open Abdomen: Balancing Pathophysiologic Benefits
and Risks in the Era of Improved Resuscitation Practices . . . . . . . . . . 55
Derek J. Roberts, Jimmy Xiao, and Andrew W. Kirkpatrick
5 Indications for Open Abdomen in the Non-trauma Setting . . . . . . . . . 73
Hany Bahouth and Yoram Kluger
6 The Open Abdomen in Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Walter L. Biffl and Ernest E. Moore
7 Open Abdomen in Patients with Abdominal Sepsis . . . . . . . . . . . . . . . 95
Massimo Sartelli, Federico Coccolini, Fausto Catena,
and Luca Ansaloni
8 Open Abdomen in Acute Pancreatitis . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Ari Leppäniemi
9 The Open Abdomen in Non-traumatic Vascular Emergencies. . . . . . 109
S. Acosta, A. Wanhainen, and M. Björck
10 The Management of the Open Abdomen: The Temporary
Closure Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Giulia Montori, Federico Coccolini, Matteo Tomasoni,
Paola Fugazzola, Marco Ceresoli, Fausto Catena, and Luca Ansaloni
11 The Role of Instillation in Open Abdomen Management . . . . . . . . . . 135
Martin Rosenthal and Marc de Moya