What Are Temporary Abdominal Closure Techniques?

The techniques of TAC are varied, and each has its advantages and disadvantages.

A temporary abdominal closure (TAC) is performed when abdominal compartment syndrome (ACS) is the concern and the abdomen is left intentionally open during surgery. ACS is a condition that increases the pressure in the abdomen (intra-abdominal pressure or IAP), which adversely affects the organs by exerting pressure, producing toxins and causing fluid and electrolyte imbalance in the body. ACS may be observed in people who sustained an injury or a fracture in or around the abdomen and people with infections in the abdomen. If left untreated, ACS is uniformly fatal.

ACS is most often observed during the early postoperative period after surgery on the abdomen. ACS may develop in people with the following conditions:

• Massive ascites (collection of fluid in the abdomen)/massive bleeding in the abdomen
• Ileus (loss of bowel movement)
• Hemorrhagic pancreatitis (inflammation of the pancreas associated with bleeding) 
• Pregnancy
• Cancer of the ovaries
• Ruptured abdominal aortic aneurysm (rupture of an abnormally dilated aorta that is a large blood vessel carrying oxygenated blood from the heart)
• Abdominal burns
• Liver transplant
• Polytrauma (two or more severe injuries in at least two areas of the body)

The above-mentioned conditions may reduce blood flow to the abdominal organs. It causes the release of various chemicals in the body, leading to swelling and death of cells, manifesting as organ swelling and secondary pressure effects on the lungs, heart, blood vessels, brain, and spinal cord. For the management of ACS, a defect or an opening is intentionally created in the abdominal wall during the surgery that exposes the abdominal organs. This is called an open abdomen.

To prevent and manage abdominal compartment syndrome (ACS), once a decision has been made to leave the abdomen open (or reopen it), the abdominal defect must be covered. This is termed as temporary abdominal closure (TAC).

The techniques of TAC are varied, and each has its advantages and disadvantages. All of them face a similar challenge—management of the open abdomen.

The purpose of TAC is to

• Allow abdominal organs to expand and thus prevent abdominal hypertension.
• Allow the patient to return to the critical care setting for further management.
• Allow the trauma team to assess the patient further and to define other potential life- or limb-threatening injuries.
• Control bleeding/blood clotting.
• Avoid further injury.
• Prevent fluid and protein loss from the body.
• Prevent heat loss from the body.

There are various techniques for TAC such as:

• Towel-clipping of skin edges: It is one of the simplest and fastest forms of TAC. Towel clips are placed 1 cm apart and 1 cm away from each side of the skin edge. As many as 30 towel clips may be required to close an incision. The incision may then be covered with an adherent plastic drape.
• Open packing of the abdomen: In this technique, the open abdomen is covered with a rayon cloth.
• Zipper closure: In this technique, a zipper is sewn on the surface of the abdomen with continuous sutures.
• Wittmann patch: It involves a Wittmann patch sheet sutured to the abdominal wall with a Velcro-like closure (one sheet with hooks and the other with loops).
• Synthetic mesh closure: Here, a mesh of synthetic material such as polytetrafluoroethylene or polypropylene–polyethylene mesh is used.
• Silastic (plastic bag) closure: Here, a sterilized soft 3-L plastic cystoscopy fluid irrigation bag is cut and shaped to cover the abdominal incision and exposed organs.

The abdominal washout procedure is a technique in which the inside of the abdomen (abdominal cavity) is irrigated with a sterile solution (such as normal saline) to “clean” the abdominal cavity, including the organs. Abdominal washouts help prevent infections that may develop in wounds following the surgery or severe trauma. These infections can prevent the wound from healing, leading to the spread of infections throughout the body.