Technique of temporary abdominal closure in abdominal compartment syndrome for preventing environmental contamination: seal and continuous high-pressure aspiration

Objective

In abdominal compartment syndrome (ACS), which is known as a lethal complication with severe peritonitis or intraperitoneal and retroperitoneal massive bleeding, we often cannot close the abdominal wound and have to adopt a strategy called open abdomen because of intestinal and retroperitoneal bulky edema. Exudate and blood in these cases is too massive to be completely absorbed by dressing gauze. Spilled exudate and blood from an abdominal open wound and dressing gauze easily causes contamination to the environment. We can prevent contamination by the exudate and bleeding with the 'seal and continuous high pressure aspiration method (S-CHPA)'. The aim of this study is to clarify the usefulness of SCHPA.

Patients and methods

The procedure of S-CHPA was as follows; a sump tube wrapped in gauze was inserted in the abdominal open wound apart from the wound, and the wound was sealed by a surgical drape. We examined the spread of contamination of exudate and blood from the abdominal wound, the volume of exudate and blood from the abdominal wound, the frequency of dressing change, and complications due to S-CHPA or the open abdomen in seven patients with ACS.

Results

Concerning the spread of contamination of exudate and blood from the abdominal wound, there was no contamination to the environment because of complete aspiration with a completely sealed negative-pressure system, and aspirated exudate and blood in the disposable bag was wasted as a closed system without spreading contamination. No exudate and blood spilled over beyond the sealed drape and closed system. Exudate and blood was completely aspirated into the disposable bag, whose weight was able to be accurately and easily measured (247 ± 269 g/hour). On the contrary, the volume of exudate and blood soaked into the gauze dressing the wound and the drain was only 6 ± 16 g/day.

The frequency of dressing change except for the daily routine one was 0 per day in this procedure. There are no complications concerning S-CHPA and infectious complications due to foreign bodies such as plastic infusion bag or massive sponge reaft in the peritoneal cavity.

Conclusion

S-CHPA is a useful procedure for open abdomen patients to prevent contamination to the environment. This procedure is also useful for exact measuring of fluid loss and blood loss, exact evaluation of the total water balance, and the saving cost of dressing sponges and costs of labor for dressing changes.