25.0: Thursday, March 17, 2005

Multidisciplinary Approach to Abdominal Wall Reconstruction after Decompressive Laparotomy for Abdominal Compartment Syndrome

Broc L. Pratt, MD, Sumeet S. Teotia, MD, Bruce A. Cairns, MD, Lindsee McPhail, MD, Edmund Rutherford, MD, Preston Rich, MD, Christopher Baker, MD, Anthony Meyer, MD, PhD, and C. Scott Hultman, MD.

Introduction: Decompressive laparotomy for abdominal compartment syndrome (ACS) has been shown to reduce mortality in critically ill patients, but little is known about the outcome of abdominal wall reconstruction.

Methods: We performed a retrospective review of 82 consecutively critically ill patients who underwent decompressive laparotomy for ACS from April 2000 to May 2004. Patients reconstructed by trauma surgeons alone (n=15) were compared with patients reconstructed jointly with plastic surgeons (n=12).

Results: Eighty-two patients underwent decompressive laparotomy for ACS, yielding 50 survivors (61%). Of the 27 patients who underwent abdominal wall reconstruction, 6 had early primary fascial repair and 21 had staged reconstruction. Compared with patients whose reconstruction was performed by trauma surgeons, patients who underwent a combined approach with plastic surgeons were older (p<0.05), had more co morbidities (p<0.001), were less likely to have a traumatic etiology (p<0.001), had a longer delay to reconstruction, (p<0.05), and were more likely to undergo components separation (p<0.05).

Conclusions: A multidisciplinary approach is essential to the successful management of abdominal wall defects after decompressive laparotomy for ACS. High risk patients with large defects and co-morbidities appear to benefit from the involvement of a plastic surgeon.