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In vitro comparison of intra-abdominal hypertension development after different temporary abdominal closure techniques

Emanuel Benninger, Ludwig Labler, Burkhardt Seifert, Otmar Trentz, Michael D Menger & Christoph Meier

abstract

BACKGROUND
To compare volume reserve capacity (VRC) and development of intra-abdominal hypertension after different in vitro temporary abdominal closure (TAC) techniques.

METHODS
A model of the abdomen was designed. The abdominal wall was simulated with polychloroprene, a synthetic rubber compound. A lentil-shaped defect of 150 cm(2) was cut into the anterior aspect of the abdominal wall. TAC of this defect was performed by a zipper system (ZS), a bag silo closure (BSC), or a vacuum assisted closure (VAC) with subatmospheric pressures ranging from 0- to 200 mmHg. The model with intact abdominal wall served as reference. The model was filled with water to baseline level. The intra-abdominal pressure was increased in 2 mmHg steps from baseline level (6 mmHg) to 40 mmHg by adding volume to the system according to a standardized protocol. VRC with corresponding intra-abdominal pressure were analyzed and compared for the different TAC techniques.

RESULTS
VRC was the highest after BSC at all pressure levels studied (P < 0.05). VAC and ZS resulted in significantly lower VRC compared with BSC and reference (P < 0.05). The magnitude of negative pressure on the VAC did not significantly influence the VRC.

CONCLUSIONS
In the present in vitro model, BSC demonstrated the highest VRC of all evaluated TAC techniques. Different levels of subatmospheric pressures applied to the VAC did not affect VRC. The results for ZS and VAC indicate that these TAC techniques may increase the risk for recurrent intra-abdominal hypertension and should therefore not be used in high-risk patients during the initial phase after abdominal decompression.
   
citation benninger e, Labler L, Seifert B, Trentz O, Menger M D, Meier C. In vitro comparison of intra-abdominal hypertension development after different temporary abdominal closure techniques. J Surg Res 2007; 144:102-6.
   
type journal paper/review (English)
date of publishing 30-08-2007
journal title J Surg Res (144/1)
ISSN print 0022-4804
pages 102-6
PubMed 17764694
DOI 10.1016/j.jss.2007.02.021