Long-Term Outcomes After Open Abdomen for ACS: Complex Abdominal Wall Reconstructions and Entero-Atmospheric Fistulas

Complex abdominal wall defects represent one of the more challenging dilemmas faced by general surgeons. Such defects may result from incisional hernia related to multiple abdominal operations, surgical resection of the abdominal wall, necrotizing abdominal wall infections, or therapeutic open abdomen, and can be complicated by the presence of an entero-atmospheric fistula. Many of these abdominal wall defects can be quite large and are often associated with a significant loss of abdominal domain. Careful planning and advanced surgical techniques are required, often involving the use (alone or combined) of biologic mesh and composite tissue transfer. Furthermore, while abdominal reconstruction in patients with or without fistulas and abdominal defects is challenging and complex, and is associated with significant morbidity and potential mortality, the abdominal wall reconstruction offers the only possible option to significantly improve the quality of life of this group of patients.