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2016 ; 11
(ä): 28
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Anatomical, physiological, and logistical indications for the open abdomen: a
proposal for a new classification system
#MMPMID27307788
Rezende-Neto J
; Rice T
; Abreu ES
; Rotstein O
; Rizoli S
World J Emerg Surg
2016[]; 11
(ä): 28
PMID27307788
show ga
BACKGROUND: A systematic approach to the appropriate use of the open abdomen
strategy has not been described. We propose three fundamental reasons for the use
of this strategy, anatomical, physiological and logistical. Anatomical reasons
pertain to the inability to bring the fascial edges together including soft
tissue defects. Physiological reasons relate to features of systemic dysfunction.
Logistical reasons involve any anticipated abdominal re-intervention while
preserving fascia. These categories occur either as a single reason or in any
combination. METHODS: A single-center prospective observational study of patients
with open abdomens in trauma and acute abdomen. Surgeons were asked to select
from the three reasons (single or any combination of) their motivation for using
the open abdomen upon completion of the initial operation. Patients were compared
using the non-parametric Wilcoxon two-sample test or Kruskal-Wallis test.
Chi-square or Fisher's exact test was used for categorical variables; Statistical
significance set at P-value???0.05. RESULTS: Forty-five consecutive patients with
open abdomens were evaluated (Jan. 1- Dec. 31, 2012). Mean age was 38.8 years, 32
were male, 39 (86.7 %) sustained trauma. The most common single reason for the
open abdomen was physiological (24.4 %), 33 patients had multiple reasons, the
most common combination being anatomical and physiological (22.2 %). A
physiological reason was linked to: lower pH, higher lactate, and lower systolic
blood pressure on admission (p?0.05). A logistical reason was associated with
earlier primary fascial closure, intra-operative packing, and bowel left in
discontinuity. Logistic regression and adjusted odds ratio of primary fascial
closure was: physiological (0.08, 95 % CI, 0.01-0.92, p?=?0.043); logistical
(6.03, 95 % CI, 1.13-32.29, p?=?0.036); and anatomical (0.83, 95 % CI, 0.16-4.18,
p?=?0.816). CONCLUSION: We defined three basic indications for the use of the
open abdomen, anatomical physiological and logistical. These indications
establish a practical and comprehensive terminology that could help to promote
appropriate use of the open abdomen.