Narrative Review of Open Abdomen Management and Comparison of Different Temporary Abdominal Closure Techniques

Abstract

Introduction: The management of an abdomen kept open after life-saving intervention for patients with intra-abdominal hypertension or abdominal compartment syndrome (ACS) constitutes an inevitable measure. Various temporary abdominal closure (TAC) techniques have been developed to reduce complications, facilitate re-entry for subsequent procedures, and support improved clinical outcomes. The goal is timely, definitive closure, promoting long-term patient health with full re-establishment of abdominal wall integrity.

Methods: This review details TAC techniques and synthesizes guidelines from leading medical organizations. It examines key studies on open abdomen management, identifies research gaps, and proposes future research directions.

Results: The TAC techniques include skin closure with clips or sutures, mesh closure and dynamic retention sutures, Wittmann Patch, Bogota Bag, Barker Vacuum Pack, and commercial negative pressure therapy (NPT) systems. Leading organizations such as the World Society of the Abdominal Compartment Syndrome and the Eastern Association for the Surgery of Trauma recommend NPT systems due to their superior clinical results. These systems reduce incidences of ACS, promote primary fascial closure, and decrease mortality.

Recommendations: Successful management of the open abdomen requires tailored TAC technique selection to meet specific patient needs while considering available resources. Though commercial NPT systems provide better long-term outcomes, traditional methods like the Barker Vacuum Pack remain viable in resource-constrained environments. Future research should prioritize cost-benefit analyses to ensure that high-quality care is aligned with superior clinical outcomes.

Conclusion: The document highlights the importance of early diagnosis and closure and emphasizes the need for further studies to optimize surgical techniques and improve cost-effectiveness.

Keywords: enteroatmospheric fistula; fascial closure; negative pressure therapy; open abdomen; temporary abdominal closure.