Open abdomen: a comprehensive review


  • Gustavo E. Muñoz Delgado Department of surgery, Unidad Médica de Alta Especialidad Hospital de Especialidades Centro Médico Nacional de Occidente, Guadalajara, Jalisco, Mexico
  • Maria A. Lastra Santiago Department of surgery, Unidad Médica de Alta Especialidad Hospital de Especialidades Centro Médico Nacional de Occidente, Guadalajara, Jalisco, Mexico



Open abdomen, Surgery, Trauma


When the abdominal viscera are visible due to a defect in the abdominal wall, which is usually caused intentionally or as a result of abdominal compartment syndrome, it is referred to as an open abdomen. As a protracted open abdomen can result in problems including fluid and protein losses, intestinal fistulization, and loss of abdominal dominance, the main goals of temporal abdominal closure techniques are to prevent fluid losses and loss of dominance. There are several techniques for short-term abdominal closure, each having advantages and disadvantages. These techniques include patch closure, silo closure, and negative pressure systems based on towels and sponges. After temporary abdominal closure, the patient is monitored in the critical care unit while any required adjustments are made to the abdominal dressings. Observational studies have shown that the Wittmann Patch has the highest average rate of primary fascial closure when compared to other operations. Yet, a temporary closure of this sort might not be adequate to stop fluid loss on its own. To monitor fluid loss, a negative pressure device (sponge- or towel-based) is advised. It can be used either on its own or in combination with other techniques for closing the temporal abdominal cavity. When the sign of an open abdomen has been removed, the abdomen is closed, ideally using a major fascial closure. If primary fascial closure cannot be achieved, functional closure may be accomplished using a biological mesh inlay method. While there is a good probability of developing a posterior hernia, this treatment adds new fascial tissue where the natural fascial limits are located. The fascia defect may be filled in with primary skin closure or skin grafts once a layer of granulation tissue has developed over the consolidated visceral mass if the space between the fascia's borders is too large for functional closure. Effective abdominal closure and the prevention of issues ultimately depend on proper management and supervision of temporary abdominal closure.


Rogers WK, Garcia L. Intraabdominal hypertension, abdominal compartment syndrome, and the open abdomen. Chest. 2018;153(1):238-50.

Diaz Jr JJ, Cullinane DC, Dutton WD, Jerome R, Bagdonas R, Bilaniuk JO et al. The management of the open abdomen in trauma and emergency general surgery: part 1-damage control. J Trauma Acute Care Surg. 2010;68(6):1425-38.

Shabhay A, Shabhay Z, Chilonga K, Msuya D, Mwakyembe T, Chugulu S. Standard Urine Collection Bag as an Improvised Bogotá Bag as a Temporary Abdominal Closure Method in an Open Abdomen in Preventing Abdominal Compartment Syndrome. Case Rep Surg. 2021;1.

Attard JAP, MacLean AR. Adhesive small bowel obstruction: epidemiology, biology and prevention. Canadian J Surg. 2007;50(4):291.

Sartelli M, Abu-Zidan FM, Ansaloni L, Bala M, Beltrán MA, Biffl WL, Moore EE. The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper. World J Emergency Surg. 2015;10(1):1-11.

Barrow E. Abdominal sepsis and abdominal compartment syndrome. Core Topics in General and Emergency Surgery E-Book: Companion to Specialist Surgical Practice. 2013;328.

Tkatch L, Rapin CH, Rizzoli R, Slosman D, Nydegger V, Vasey H et al. Benefits of oral protein supplementation in elderly patients with fracture of the proximal femur. J Am College Nutr. 1992;11(5):519-25.

Albo D, Hawn MT. Operative Techniques in Colon and Rectal Surgery. Lippincott Williams and Wilkins. 2023.

Frazee RC, Abernathy SW, Jupiter DC, Smith RW. The number of operations negatively influences fascia closure in open abdomen management. Am J Surg. 2012;204(6):996-9.

Bartlett DC, Kingsnorth AN. Abdominal wound dehiscence and incisional hernia. Surgery (Oxford). 2006;24(7):234-8.

Burch J. Psychological problems and stomas: a rough guide for community nurses. Br J Community Nurs. 2005;10(5):224-7.

Quyn AJ, Johnston C, Hall D, Chambers A, Arapova N, Ogston S et al. The open abdomen and temporary abdominal closure systems–historical evolution and systematic review. Colorectal Dis. 2012;14(8):e429-e438.

Atema JJ, Gans SL, Boermeester MA. Systematic review and meta-analysis of the open abdomen and temporary abdominal closure techniques in non-trauma patients. World J Sur. 2015;39:912-25.

Petersen S, Henke G, Zimmermann L, Aumann G, Hellmich G, Ludwig K. Ventral rectus fascia closure on top of mesh hernia repair in the Sublay technique. Plastic Reconstructive Surg. 2004;114(7):1754-60.

Carlsen BT, Farmer DG, Busuttil RW, Miller TA, Rudkin GH. Incidence and management of abdominal wall defects after intestinal and multivisceral transplantation. Plastic Reconstructive Surg. 2007;119(4):1247-55.

Jones GA, Butler J, Lieberman I, Schlenk R. Negative-pressure wound therapy in the treatment of complex postoperative spinal wound infections: complications and lessons learned using vacuum-assisted closure. J Neurosurg Spine, 2007;6(5):407-11.

Cheatham ML, Safcsak K, Llerena LE, Morrow Jr CE, Block EF. Long-term physical, mental, and functional consequences of abdominal decompression. J Trauma Acute Care Surg. 2015;56(2):237-42.

Bee TK, Croce MA, Magnotti LJ, Zarzaur BL, Maish III GO, Minard G et al. Temporary abdominal closure techniques: a prospective randomized trial comparing polyglactin 910 mesh and vacuum-assisted closure. J Trauma Acute Care Surg. 2008;65(2):337-44.






Review Articles