Management of the Open Abdomen Patient

The concept of ‘abbreviated laparotomy’ and the practice of leaving the peritoneal cavity open was first described in trauma patients by Stone in 1983 and became an acceptable surgical strategy after a landmark paper in 1993 (Stone HH et al. Ann Surg. 1983;197(5):532–535; Rotondo MF, et al. J Trauma. 1993;35(3):383). The open abdomen strategy involves carrying out only life-saving procedures at the index operation, leaving the abdominal wall open, and covering the exposed viscera with a temporary abdominal dressing. Abbreviated laparotomy, also known as “staged” or “damage control” laparotomy, allows for immediate management of life-threatening conditions in patients who are too critically ill to otherwise withstand definitive operative repair. Definitive repair is then deferred to a time when physiologic homeostasis had been reestablished. In the last two decades, the indications for damage control laparotomy have expanded to also include emergency general surgery (Nagpal S, et al. J Trauma. 2009;67(5):152; Allardyce DB. Am J Surg. 1987;154(3):295–299; Soop M and Carlson GL. Br J Surg. 2017;104(2):e74; Wertheimer MD and Norris CS. Arch Surg. 1986;121(4):484–487). However, whereas damage control laparotomy is considered standard of care in trauma surgery, its role is more controversial and less well defined in emergency general surgery.