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

D. L. Ciresi, R. F. Cali, A. J. Senagore, R. Albrecht, L. N. Diebel, D. Moorman

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

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 recommended as a means of managing ACS. However, use of absorbable prosthetic has been associated with very high rates of intestinal fistula formation and ventral hernia formation. The purpose of this study was to retrospectively review our experience with the use of nonabsorbable prosthetic abdominal closures 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 evaluated. A total of 18 patients were identified: 15 primary prosthetic placements (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 multisystem 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 patients who died of multisystem organ failure within the same hospitalization. Delayed abdominal closure at a subsequent admission was performed in two cases. This same patient developed an enterocutaneous fistula 2 months after discharge. Importantly, only 1 of 18 closed in this manner developed ACS requiring reoperation. The results indicate that use of a nonabsorbable prosthetic, particularly with Gore-Tex(TM), is efficacious in the prevention of postoperative ACS in high-risk patients, while it enhances the possibility for delayed abdominal closure and minimizes the risk of gastrointestinal fistulization associated with other techniques.

Original languageEnglish (US)
Pages (from-to)720-725
Number of pages6
JournalThe American surgeon
Volume65
Issue number8
StatePublished - 1999
Externally publishedYes

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Intra-Abdominal Hypertension
Resuscitation
Fistula
Intestinal Fistula
Aortic Rupture
Polypropylenes
Abdominal Aortic Aneurysm
Ventral Hernia
Closed Head Injuries
Wounds and Injuries
Abdominal Wall
Heart Arrest
Reoperation
Hospitalization

ASJC Scopus subject areas

  • Surgery

Cite this

Ciresi, D. L., Cali, R. F., Senagore, A. J., Albrecht, R., Diebel, L. N., & Moorman, D. (1999). Abdominal closure using nonabsorbable mesh after massive resuscitation prevents abdominal compartment syndrome and gastrointestinal fistula. The American surgeon, 65(8), 720-725.

Abdominal closure using nonabsorbable mesh after massive resuscitation prevents abdominal compartment syndrome and gastrointestinal fistula. / Ciresi, D. L.; Cali, R. F.; Senagore, A. J.; Albrecht, R.; Diebel, L. N.; Moorman, D.

In: The American surgeon, Vol. 65, No. 8, 1999, p. 720-725.

Research output: Contribution to journalArticle

Ciresi, DL, Cali, RF, Senagore, AJ, Albrecht, R, Diebel, LN & Moorman, D 1999, 'Abdominal closure using nonabsorbable mesh after massive resuscitation prevents abdominal compartment syndrome and gastrointestinal fistula', The American surgeon, vol. 65, no. 8, pp. 720-725.
Ciresi, D. L. ; Cali, R. F. ; Senagore, A. J. ; Albrecht, R. ; Diebel, L. N. ; Moorman, D. / Abdominal closure using nonabsorbable mesh after massive resuscitation prevents abdominal compartment syndrome and gastrointestinal fistula. In: The American surgeon. 1999 ; Vol. 65, No. 8. pp. 720-725.
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