Temporary Closure of the Abdomen

Temporary Abdominal Closure

Once the decision has been made to leave the abdomen open, the most optimal TAC technique should be used. This technique should be based on the experience of the surgeon and the practice environment. An ideal TAC should have the following attributes:

• Easily encompasses the bowel and abdominal viscera

• Allows enlargement of the abdominal cavity in situations of massive bowel, tissue, or retroperitoneal edema without inducing IAH and while preventing ACS

• Is expansible but also sturdy enough to permit the tamponade effect of packing the liver or other bleeding surfaces

• Does not damage the fascia and prevents fascial retraction

• Contains and quantifies fluid loss

• Prevents adhesion formation between viscera and abdominal fascia

• Promotes removal of infectious materials

• Is quick to apply and remove

• Has a good primary fascial closure rate

Table 73-1-1 compares the most common methods of TAC. Although the earliest forms of TAC, the towel clip closure and Bogotá bag closure, are mentioned in the table, these have been largely replaced by more improved options. Similarly, polypropylene (Prolene; Ethicon, Somerville, NJ); polytetrafluoroethylene (PTFE) (Gore-Tex; W.L. Gore & Associates, Flagstaff, Ariz.); biologic mesh, such as human acellular dermal matrix, or HADM (Alloderm; Lifecell, Branchburg, NJ); and bovine acellular collagen matrix (Surgimend; TEI Biosciences, Boston, Mass.) are rarely used anymore for TAC. These materials were abandoned for a number of reasons. Polypropylene is notorious for developing fistulas and is difficult to remove from the bowel; PTFE, although relatively inert, limits tissue granulation, is not well incorporated in the fascia, and carries a high risk of mesh infection. The biologic mesh matrix products are too expensive for temporary use and may not provide enough tensile strength, especially in heavily infected fields, where they have been known to “melt away.”