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The open abdomen (OA) is not a new idea. In 1897 Andrew McCosh describe its use in diffuse peritonitis, in 1894 Körte used it in necrotic pancreatitis. In 1940 the military surgeon W.H. Ogilvie reported two cases in which he left abdomen open. In the middle of XX century Gross and Schuster used it in the treatment of large omphalocele in children. Nowadays, there is consensus about the indication for OA – severe diffuse peritonitis with insufficient control of the primary source of infection, damage control surgery in trauma, abdominal compartment syndrome, need for second look. Various technique for temporary abdominal closure (TAC) have been described which clearly indicates that the ideal technique is not yet available. These are open packing, skin closure with towel clips, Bogota bag, mesh, mesh-zipper, mesh-foil (Figure 1), palisade dorsoventral drainage (Figure 2), Wittmann patch, negative pressure wound therapy. During the years TAC® evolved from a passive dressing to active approach with negative pressure. In 1986 M. Schein published in BJS the so-called “sandwich technique” which is the first use of negative pressure in open abdomen (1). After 1994 negative pressure wound therapy (NPWT, home-made or commercial vacuum assisted closure) have gained tremendous popularity. Along with traditional home made Barker‘s vacuum pack several commercial products have been released into the practice: V.A.C.® (KCI), Vivano® (Hartmann), Renasys® (Smith & Nephew). Actually, the pioneers from Wake Forest University in North Carolina replaced the gauze with polyurethane foam in 1996. Despite the growing body of literature high level of evidence about open abdomen management are still lacking (2). This is may be due to the inherent difficulties to perform randomized controlled trial in emergency setting. The following advantages in comparison to passive dressings has been claimed: increased primary fascial closure, lower rate of adhesions, diminished bacterial count, better qualitative and quantitative analysis of the fluid, increased survival and significantly easier nursing. The critical analysis, however, revealed significantly more complicated situation. Recent systematic review and meta-analysis of only comparative

il giornale di chirurgia/il giornale di chirurgia

The open abdomen - still a challenge for the surgeons. Which is the best technique for temporary abdominal closure? A focus on negative pressure wound therapy