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Critical Care
Published in: Critical Care 2/2006

Open Access 01-04-2006 | Research

Decompressive laparotomy for abdominal compartment syndrome – a critical analysis

Authors: Jan J De Waele, Eric AJ Hoste, Manu LNG Malbrain

Published in: Critical Care | Issue 2/2006

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Abstract

Introduction

Abdominal compartment syndrome (ACS) is increasingly recognized in critically ill patients, and the deleterious effects of increased intraabdominal pressure (IAP) are well documented. Surgical decompression through a midline laparotomy or decompressive laparotomy remains the sole definite therapy for ACS, but the effect of decompressive laparotomy has not been studied in large patient series.

Methods

We reviewed English literature from 1972 to 2004 for studies reporting the effects of decompressive laparotomy in patients with ACS. The effect of decompressive laparotomy on IAP, patient outcome and physiology were analysed.

Results

Eighteen studies including 250 patients who underwent decompressive laparotomy could be included in the analysis. IAP was significantly lower after decompression (15.5 mmHg versus 34.6 mmHg before, p < 0.001), but intraabdominal hypertension persisted in the majority of the patients. Mortality in the whole group was 49.2% (123/250). The effect of decompressive laparotomy on organ function was not uniform, and in some studies no effect on organ function was found. Increased PaO2/FIO2 ratio (PaO2 = partial pressure of oxygen in arterial blood, FiO2 = fraction of inspired oxygen) and urinary output were the most pronounced effects of decompressive laparotomy.

Conclusion

The effects of decompressive laparotomy have been poorly investigated, and only a small number of studies report its effect on parameters of organ function. Although IAP is consistently lower after decompression, mortality remains considerable. Recuperation of organ dysfunction after decompressive laparotomy for ACS is variable.
Appendix
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Metadata
Title
Decompressive laparotomy for abdominal compartment syndrome – a critical analysis
Authors
Jan J De Waele
Eric AJ Hoste
Manu LNG Malbrain
Publication date
01-04-2006
Publisher
BioMed Central
Published in
Critical Care / Issue 2/2006
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc4870

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