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Intra-abdominal pressure development after different temporary abdominal closure techniques in a porcine model

Emanuel Benninger, Matthias W Laschke, Markus Cardell, Marius Keel, Burkhardt Seifert, Otmar Trentz, Michael D Menger & Christoph Meier

abstract

BACKGROUND
Decompressive laparotomy followed by temporary abdominal closure (TAC) is an established prophylaxis and treatment for abdominal compartment syndrome. The herein presented study aimed at the comparison of volume reserve capacity and development of intra-abdominal hypertension after forced primary abdominal closure and different TAC techniques in a porcine model.

METHODS
Eight anesthesized and mechanically ventilated domestic pigs underwent a standardized midline laparotomy. A bag was placed into the abdominal cavity. Before abdominal closure, the bag was prefilled with 3,000 mL water to simulate increased intra-abdominal volume. The intra-abdominal pressure (IAP) was then increased in 2 mm Hg steps up to 30 mm Hg by adding volume (volume reserve capacity) to the intra-abdominal bag. Volume reserve capacity with the corresponding IAP were analyzed and compared for primary abdominal closure, bag silo closure, a zipper system, and vacuum-assisted closure (VAC) with different negative pressures (-50, -100, and -150 mm Hg). Hemodynamic and pulmonary parameters were monitored throughout the experiment.

RESULTS
Volume reserve capacity was the highest for bag silo closure followed by the zipper system and VAC with primary abdominal closure providing the least volume reserve capacity in the whole IAP range. Of interest, VAC -50 mm Hg resulted in a lower volume reserve capacity when compared with VAC -100 and -150 mm Hg. Pulmonary and hemodynamic parameters demonstrated no significant differences between primary abdominal closure and the evaluated TAC techniques at all IAP levels.

CONCLUSIONS
The present experimental in vivo study indicates that bag silo closure and zipper systems may be favorable TAC techniques after decompressive laparotomy. In contrast, the VAC techniques resulted in lower volume reserve capacity and therefore may bear an increased risk for recurrent intra-abdominal hypertension in the initial phase after decompressive laparotomy.
   
citation benninger e, Laschke M W, Cardell M, Keel M, Seifert B, Trentz O, Menger M D, Meier C. Intra-abdominal pressure development after different temporary abdominal closure techniques in a porcine model. J Trauma 2009; 66:1118-24.
   
type journal paper/review (English)
date of publishing 4-2009
journal title J Trauma (66/4)
ISSN electronic 1529-8809
pages 1118-24
PubMed 19359923
DOI 10.1097/TA.0b013e3181820d94