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.