This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Abdominal content containment: practicalities and outcome. BJS 2000; 87: 106-109.
Published: 10th December 2002
Authors: F. Ghimenton, S. R. Thomson, D. J. J. Muckart, R. Burrows
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.
Method
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.
Conclusion
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. © 2000 British Journal of Surgery Society Ltd
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