| Abstract: Abstract
Aim
The aim of this prospective pilot study was to determine the feasibility of a novel technique of laparostomy closure utilising an adjustable polypropylene mesh corset.
Methods
Six patients with acute laparostomies following trauma or sepsis were randomly selected for this pilot study. After corset placement, clinical progress was monitored and meshes were adjusted as required. This involved tensioning the mesh for progressive laparostomy closure, or relaxation in the face of rising intra-abdominal pressure. The technique utilises polypropylene mesh sutured to the deep musculo-aponeurotic fascia of the abdominal wall in a corset-like construct that can be tightened or loosened at the bedside without anaesthesia. The corset is overlain by drains, a further sheet of mesh then an occlusive dressing. The corset may be split for therapeutic relaparotomies and reconstituted without loss of function.
Results
Three patients required no laparotomies between mesh placement and removal. All laparostomies were closed within ten days without complication, and were easily managed in both intensive care and ward-based settings.
Discussion
Successful management and closure of the open abdomen remains a difficult challenge. With the aid of intra-abdominal pressure monitoring1 and repeated clinical examination, this technique can allow for the applied abdominal wall tension can be kept below the level that can cause abdominal compartment syndrome2 , and can facilitate controlled closure of the musculoaponeurotic defect once the acute phase has passed . As a safety feature, the corset allows controlled decompression of the abdomen in the event of progressively rising intra-abdominal pressure, thereby avoiding the negative, and sometimes fatal consequences of rapid decompression of the abdomen3. The technique may reduce the number of unnecessary, non-therapeutic laparotomies performed for reduction or “reefing” of the mesh as part of staged abdominal closure. This small pilot study has demonstrated that application of the musculo-aponeurotic corset is technically feasible. Corset adjustment can be done in a critical care setting or on the surgical wards safely, simply and at any time the clinician chooses or the patient’s condition dictates.
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