Comparison of early surgical alternatives in the management of `Open abdomen?: A randomized prospective study

Objective: Abdominal Compartment Syndrome (ACS); is characterized with sudden and pathologic increase of the pressure of the abdomen who has a limited anatomic space. It is a highly mortal clinical entity if not treated promptly. Progressive increase of the intraabdominal pressure causes systemic response. Treatment of the ACS is based on decreasing the abdominal pressure. Clinical condition of the patient is the most important criteria in making the desicion of decompressive laparotomy. In grade 3 and 4 ACS patients abdominal closure is not performed after decompressive laparotomy, instead, open laparostomy is preferred in order to keep the abdominal pressure in low ranges. In the present study we aimed to investigate two different temporary closure methods, Vacuum assisted closure (VAC) and Bogota bag techniques, in 40 patients who were performed decompressive laparotomy.Material/ Methods: 40 patients who were edmitted to the Çukurova University Medical Faculty Intensive Care Unit of General Surgery with ACS following trauma, prior abdominal surgery or other reasons and who were performed decompressive laparotmy as a part of their treatment were enrolled to the study. VAC and Bogota bag were performed as temporary closure methods and clinical, laboratory, mortality and morbidity results were compared.Results: Demographic features of the patients (age, sex, body mass index, comorbidities) were similar between the two groups. The most common reason of ACS was gastrointetsinal perforation in 12 (30%) patients. The width of the incision decreased significantly faster in the VAC group. The patients were appropriate to primary closure of the fascia in 16.9 days in the VAC group and 20,5 days in the Bogota bag group. Arterial blood gas showed statistically significantly better results in SPO2, PO2, PCO2 and pH values in the VAC group. We found that renal function tests decreased faster and got closer to normal vaşlues in the VAC group. The decrease in the abdominal pressure was similar on day 1, 4, 7 but was significantly lower on day 14 in the VAC group. 12 patients (30%) died during the study, and 5 (12%) were in the VAC group whereas 7 (17.5%) were in the Bogota bag group.Conclusion: Based on these results, we suggest that VAC has certain advantages on Bogota bag as a temporary closure method in the management of abdominal compartment syndrome.Key Words: abdominal compartment syndrome, intraabdominal hypertension, Vacuum assisted closure, Bogota Bag, Randomized clinical trial