| Abstract: INTRODUCTION: Several clinical situations lead to increases in the abdominal pressure (IAP). Decompressive surgery is a tool to consider in the treatment of patients with high IAP.
OBJECTIVE: To review our experience in decompressive surgery analysing its impact on the respiratory, haemodynamic and renal function, as well as the complications of the technique and its mortality.
MATERIAL-METHOD: Twenty-eight abdominal surgery patients, subjected to decompressive surgery. Mean age: 65 years (48-78 years), 16 males, 12 women. All patients were carrying a bladder probe, arterial catheter and pulmonary artery catheter. Determinations every 6 hours: blood pressure, heart rate, mean blood pressure, central venous pressure, mean pressure of the pulmonary artery, pulmonary capillary pressure, airways peak pressure, positive end-inspiratory pressure. Determinations every 12 hours: cardiac output, heart index, systolic volume, paO2 / FiO2 quotient, arterial pH. Determination of IAP every 6 hours by means of bladder probe. Register of complications derived from the technique, and mortality.
RESULTS: Significant differences were found regarding pre-decompressive and post-decompressive mean blood pressure (69.7 mmHg ± 11 vs. 93.3 mm Hg ± 4), p=0.001, and also regarding the pre- and post-decompressive airways peak (43 cm H2O ± 3. 8 vs. 31 cm H2O ± 5 ), p= 0.001. Pre-decompressive central venous pressure was 12 cm H2O ± 2.4, compared to a decompressive pressure of 7.2 cm H2O ±1.9, p=0.001. Pre-decompressive diuresis was 39 ml ml/h ± 9.6, while decompressive diuresis was 77 ml /h ± 13, p=0.001. There are significant differences regarding the pre-decompressive and post-decompressive IAP (16. 5 mmHg ± 3 vs. 7.2 mmHg ±1.9) , p=0. 001. No complications caused by the decompressive technique were reported. The final closure of the abdominal wall was achieved in four cases using mesh, in one case after removing the prosthesis and final closure, and in 23 patients by staged closure and removal of the mesh. Mortality was 38% (10 patients).
DISCUSSION: Decompressive surgery is a new therapeutic weapon in the surgical treatment of critical patients.
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