Abdominal closure using nonabsorbable mesh after massive resuscitation prevents abdominal compartment syndrome and gastrointestinal fistula

Patients who receive high-volume resuscitation after massive abdominopelvic trauma, or emergent repair of a ruptured abdominal aortic aneurysm (RAAA), are at a significant risk for postoperative abdominal compartment syndrome (ACS). Absorbable prosthetic closure of the abdominal wall has been recomm ended as a means of managing ACS. However, use of absorbable prosthetic has been associated with very high rates of intestinal fistula formation and v entral hernia formation. The purpose of this study was to retrospectively r eview our experience with the use of nonabsorbable prosthetic abdominal clo sures in patients with documented ACS or at high risk for ACS. All patients managed by this technique from July 1995 through July 1997 after repair of ruptured abdominal aortic aneurysm or massive abdominopelvic trauma were e valuated. A total of 18 patients were identified: 15 primary prosthetic pla cements (Gore-Tex (TM) patch, 12; Marlex (TM) mesh, 2; and silastic mesh, 1 ) and 3 delayed prosthetic placements for ACS (Gore-Tex (TM), 1 and Marlex (TM), 2). The mortality rate was 22 per cent (4 of 18) and resulted from mu ltisystem organ failure (2 patients), cardiac arrest 1 hour postoperatively (1 patient), and severe closed head injury (1 patient). Secondary closure and prosthetic removal was possible in 16 of 18 patients, including the 2 p atients who died of multisystem organ failure within the same hospitalizati on. Delayed abdominal closure at a subsequent admission was performed in tw o cases. This same patient developed an enterocutaneous fistula 2 months af ter discharge. Importantly, only 1 of 18 closed in this manner developed AC S requiring reoperation. The results indicate that use of a nonabsorbable p rosthetic, particularly with Gore-Tex (TM), is efficacious in the preventio n of postoperative ACS in high-risk patients, while it enhances the possibi lity for delayed abdominal closure and minimizes the risk of gastrointestin al fistulization associated with other techniques.