A Non-Traumatic Binder for Temporary Abdominal Wall Closure (ABRO) Multicentre Trial

At the end of most abdominal operations the fascial layer is closed primarily. However, because of logistic, physiological and or anatomical reasons, the surgeon needs to leave the abdomen open. In those circumstances, attempts to close the abdomen could potentially lead to unnecessary damage to the abdominal wall fascia, intra-abdominal hypertension, abdominal compartment syndrome and abdominal wall dehiscence post-operatively.

The use of the "open abdomen" (OA) in the post-operative period is not uncommon. Currently, three important trends provide grounds for increased use of this surgical strategy:

• Lifesaving surgical procedures in severely injured trauma patients.
• Surgical procedures performed in patients with non-traumatic surgical emergencies
• Abdominal catastrophes in elderly patients with pre-existing medical conditions. The OA is not a new strategy in the surgeon's armamentarium. A recent publication retrieved more than 1300 articles over the last 25 years relative to the management of the OA, published in the English language.5 However, the precise incidence of the OA is unknown. Nonetheless, hospitals around the world, particularly those that receive trauma victims, have an OA rate of 1-5% among their most critically ill surgical patients.

This lifesaving surgical strategy does not come without a price. The mortality rate of an OA is approximately 30%. There is also a wide range of complications linked to this procedure. The OA exposes large surface area of the body to the environment increasing fluid losses. Maintenance of adequate fluid and nutritional status of the patient are challenging in this setting.

Furthermore, the exposed abdominal cavity also poses greater risk for local contamination from external sources that could ultimately result in sepsis. Impaired abdominal wall function interferes with ventilatory mechanics. Consequently, patients with OA are prone to respiratory complications. However, the most dreaded complication of an OA is the formation of an enteroatmospheric fistula (EF). The incidence of EF is approximately 11-15%, and increases with time. Patients who have an OA for more than 8 days have an incidence of ECF as high as 25%, caused mainly by damage to the exposed bowel. Management this complication is extremely challenging, very costly, and carries a mortality rate of 36-64%.