RECLOSURE OF THE OPEN ABDOMEN

BACKGROUND: The open abdomen technique for the treatment of diffuse pe ritonitis has gained acceptance. Our approach has been to use the zipp er technique with daily irrigations, Once the abdominal problem has re solved, the mesh and zipper are removed. Surgeons are reluctant to reo perate on patients with such prior treatment because of the anticipati on of a hostile abdomen, Our study is a retrospective review of 12 pat ients who were treated with the open abdomen technique. At a later dat e, they underwent elective reoperation. STUDY DESIGN: The charts of 12 patients were reviewed. After initial injury, the patients were in th e surgical intensive care unit. Reoperations were performed nine month s (mean) after discharge from this facility. The reasons for reoperati on were closure of enteric fistula (five patients) and closure of an o stomy (seven patients). The abdominal wall was reconstructed in nine p atients. In the other three patients, the abdomen was entered through a lateral incision and the bowel was reanastomosed. RESULTS: All of th e patients survived. There were five complications. Two patients had i schemic skin grafts successfully treated by hyperbaric oxygen therapy (HBO). Two patients had ischemic skin flaps that were covering mesh. T hey responded to HBO with minimal slough of superficial tissue. One pa tient had a low output fistula that closed after two weeks of total pa renteral nutrition. CONCLUSIONS: A history of an open abdomen is not a contraindication to later operation. Bowel continuity can be restored and abdominal wall reconstruction can be performed safely. This can b e done as early as three to four months after recovery from the origin al injury.