Objective
To determine whether prevention of the abdominal compartment syndrome after celiotomy for trauma justifies the use of absorbable mesh prosthesis closure in severely injured patients.
Design
Retrospective analysis of case series from July 1, 1989, to July 31, 1996.
Setting
University-based level I trauma center.
Patients
Seventy-three consecutive trauma patients requiring celiotomy who received absorbable mesh prosthesis closure and 73 control patients matched for injury severity and trauma type who received celiotomy without a mesh prosthesis closure.
Intervention
Absorbable mesh prosthesis closure was used in cases of excessive fascial tension, abdominal compartment syndrome, necrotizing fasciitis, traumatic defect, or planned reoperation.
Main Outcome Measures
Demographics, Injury Severity Score, Abdominal Trauma Index, highest abdominal Abbreviated Injury Scale score, number of abdominal/pelvic injuries, highest head Abbreviated Injury Scale score, shock, indication for mesh closure, complications, number of operations and time required for closure, days in the intensive care unit, length of stay, and mortality were determined. The highest abdominal Abbreviated Injury Scale score was multiplied by the number of abdominal/pelvic injuries to calculate the abdominal pelvic trauma score.
Results
Group 1 consisted of 47 patients who received mesh at initial celiotomy, and group 2, 26 patients who received mesh at a subsequent celiotomy. These 2 groups were statistically similar in demographics, injury severity, and mortality. However, group 2 had a significantly higher incidence of postoperative abdominal compartment syndrome (35% vs 0%), necrotizing fasciitis (39% vs 0%), intra-abdominal abscess/peritonitis (35% vs 4%), and enterocutaneous fistula (23% vs 11%) compared with group 1 (P<.001). Group 1 patients with preoperative abdominal compartment syndrome had more abdominal/pelvic injuries and higher abdominal trauma index than matched controls (P<.05). There was a trend toward higher abdominal pelvic trauma score in patients who developed abdominal compartment syndrome. The Pearson coefficient of correlation between the abdominal trauma index and the more easily calculated abdominal pelvic trauma score was 0.91 (P<.001).
Conclusion
The use of absorbable mesh prosthesis closure in severely injured patients undergoing celiotomy was effective in treating and preventing the abdominal compartment syndrome.
Arch Surg. 1997;132:957-962
Abdominal compartment syndrome: an under-diagnosed contributory factor to morbidity and mortality in the critically ill
Hunter
Postgrad. Med. J. 2008;84:293-298.
ABSTRACT
| FULL TEXT
Supranormal Trauma Resuscitation and Abdominal Compartment Syndrome
Ivatury
Arch Surg 2004;139:225-226.
FULL TEXT
Pathophysiology and Management of Abdominal Compartment Syndrome
Walker and Criddle
Am J Crit Care 2003;12:367-371.
ABSTRACT
| FULL TEXT
Mechanism of Acute Ascites Formation After Trauma Resuscitation
Mayberry et al.
Arch Surg 2003;138:773-776.
ABSTRACT
| FULL TEXT
Dynamic Retention: A Technique for Closure of the Complex Abdomen in Critically Ill Patients
Koniaris et al.
Arch Surg 2001;136:1359-1362.
ABSTRACT
| FULL TEXT
Avoidance of Abdominal Compartment Syndrome in Damage-Control Laparotomy After Trauma
Offner et al.
Arch Surg 2001;136:676-681.
ABSTRACT
| FULL TEXT
Postoperative Complications of Temporary Abdominal Surgery
Mayberry et al.
Arch Surg 1998;133:1370-1371.
FULL TEXT
General Surgery
Organ and Porter
JAMA 1998;280:495-496.
FULL TEXT
Which Is the Optimal Technique for Temporary Abdominal Coverage?
Losanoff and Kjossev
Arch Surg 1998;133:911-911.
FULL TEXT
