Traumatic Open Abdomen

The open abdomen is a validated and widely accepted approach to managing surgical and traumatic pathologies. Traumatic open abdomen involves leaving the fascial layer of the abdomen open after a laparotomy for blunt or penetrating trauma with the intention of going back later for definitive repair and closure. It can be utilized for damage control with later closure, to facilitate re-exploration or enable additional surgical debridement, or to provide definitive surgery once the patient has stabilized.

Damage control laparotomy (DCL), more specifically, prioritizes the control of hemorrhage and contamination as well as the preservation of physiologic reserves. It is useful in patients who cannot tolerate a prolonged operation. The patient's abdomen is left open with a delay in fascial closure until after visceral injuries can be definitively managed. This is a key benefit of the traumatic open abdomen.

After the initial procedure, the patient is cared for in the intensive care unit (ICU). Patients are assessed on 24 to 48-hour cycles for readiness to return to the operating room. Washouts are performed as needed during this interval. Signs that a patient is ready to return to the operating room include stabilization of vital signs, urine output, urinary bladder pressure, physiological stabilization, and no signs of abdominal infection.

Patients who undergo primary closure during the index hospitalization have shorter intensive care unit (ICU) stays, hospital stays, and quality of life. At least one study found that undergoing more than four operations before primary closure is achieved was significantly associated with failure of the primary fascial closure, while another found that achieving primary closure within eight days of the initial operation was associated with better outcomes.

Additionally, providing enteral nutrition to patients with an open abdomen is another factor that increases the likelihood of successful primary closure. It has also been shown to reduce mortality in these patients compared to those who are kept nil per os (NPO or nothing by mouth). After the shock has resolved, enteral nutrition should be considered in all patients with an open abdomen.