What is a temporary abdominal closure done for?
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.
What are temporary abdominal closure techniques?
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.
What is an abdominal washout procedure?
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.
SLIDESHOW
Appendix Pain? Appendicitis, Surgery, and More See SlideshowHealth Solutions From Our Sponsors
Top What Are Temporary Abdominal Closure Techniques? Related Articles
Abdominal Pain (Causes, Remedies, Treatment)
Abdominal pain can have many causes that range from mild to severe. Some of these causes include bloating, gas, colitis, endometriosis, food poisoning, GERD, IBS (irritable bowel syndrome), ovarian cysts, abdominal adhesions, diverticulitis, Crohn's disease, ulcerative colitis, gallbladder disease, liver disease, and cancers. Signs and symptoms of the more serious causes include dehydration, bloody or black tarry stools, severe abdominal pain, pain with no urination or painful urination. Treatment for abdominal pain depends upon the cause.
Abdominal Pain Pictures
Abdominal pain is a symptom of many possible conditions including appendicitis, ulcers, irritable bowel syndrome, indigestion, and other conditions. It may accompany constipation, diarrhea, vomiting, and other symptoms. Find out the potential causes of pain in the abdomen and learn when you should see a doctor.
Children's Abdominal Pain
Abdominal pain in children can be more than just a tummy ache. What are the common causes of abdominal pain in children? Learn about pediatric abdominal pain symptoms like rash, vomiting, diarrhea, and fever. What is the best treatment for stomach pain in children?
Ectopic Pregnancy (Tubal Pregnancy)
An ectopic pregnancy is a pregnancy located outside the inner lining of the uterus. The majority of ectopic pregnancies occur in the Fallopian tube. Signs and symptoms of an ectopic pregnancy may include abdominal pain, lack of menstrual period (amenorrhea), vaginal bleeding, fainting, dizziness, and low blood pressure.
Treatment options for an ectopic pregnancy include observation, medication, or surgery.
Liver Transplant
A liver transplant may be needed when the liver functions inadequately. Patients on the waiting list for a liver transplant are given a priority score based on their creatinine, bilirubin, and INR. Complications of liver transplantation include rejection of the donor organ and infection.
Acute and Chronic Pancreatitis
Pancreatitis is a rare disease in which the pancreas becomes inflamed. There are two types of pancreatitis: acute and chronic. Symptoms of pancreatitis include abdominal pain, fever, nausea, vomiting, and a rapid pulse. Treatment of pancreatitis often requires hospitalization.
Pancreatitis Quiz
What does the pancreas do, and what happens in the body that causes pancreatitis? Test your medical IQ of pancreatitis with this quiz!
Pregnancy (Week by Week, Trimesters)
Signs and symptoms of pregnancy vary by stage (trimester). The earliest pregnancy symptom is typically a missed period, but others include breast swelling and tenderness, nausea and sometimes vomiting, fatigue, and bloating. Second trimester symptoms include backache, weight gain, itching, and possible stretch marks. Third trimester symptoms are additional weight gain, heartburn, hemorrhoids, swelling of the ankles, fingers, and face, breast tenderness, and trouble sleeping. Eating a healthy diet, getting a moderate amount of exercise, also are recommended for a healthy pregnancy. Information about the week by week growth of your baby in the womb are provided.
Early Pregnancy Symptoms and Signs
Pregnancy symptoms can vary from woman to woman, and not all women experience the same symptoms. When women do experience pregnancy symptoms they may include symptoms include missed menstrual period, mood changes, headaches, lower back pain, fatigue, nausea, breast tenderness, and heartburn. Signs and symptoms in late pregnancy include leg swelling and shortness of breath. Options for relief of pregnancy symptoms include exercise, diet, and other lifestyle changes.
Bleeding During Pregnancy (First Trimester)
Bleeding during pregnancy is never normal. Causes of bleeding during the first trimester of a pregnancy may be caused by implantation bleeding, ectopic or tubal pregnancy, subchorionic hemorrhaging, infections, and miscarriage. Bleeding during the second and third trimesters of pregnancy can be caused by a variety of factors.
Pregnancy: Prenatal Care and Tests
Prenatal care is important for the health of the mother and the baby. Common prenatal tests include ultrasound, amniocentesis, screening for group B strep, and chronic villus sampling. Prenatal care also helps detect health conditions related to pregnancy, such as preeclampsia and gestational diabetes. Prenatal care costs can be expensive, but services are available to help women get the care they need.
Pregnancy: 7 Common Third Trimester Tests
Testing is often recommended during the third trimester of pregnancy. These tests are designed to ensure the health and safety of both the child and mother. Common tests during the third trimester of a woman's pregnancy include:- group B streptococcus screening,
- electronic fetal heart monitoring,
- nonstress test,
- contraction stress test, and
- a biophysical profile.
What Is Fascial Closure?
Fascial closure is the closure of the inner layers of the abdomen after a major surgery involving an incision on the abdomen. Fascial closure prevents hernia formation. The fascial closure technique is of two types: layered closure and mass closure. Fascial closure is usually indicated for surgery on the abdominal cavity and trauma.