International Wound Journal ISSN 1742-4801

ORIGINAL ARTICLE

Laparostomy management using the ABThera™ open

abdomen negative pressure therapy system in a grade IV
open abdomen secondary to acute pancreatitis
James EF Fitzgerald1 , Shradha Gupta2 , Sarah Masterson3 & Helgi H Sigurdsson2
1 Emergency General Surgery, Department of General Surgery, Chelsea & Westminster NHS Hospital Trust, London, UK
2 Department of General Surgery, Chelsea & Westminster NHS Hospital Trust, London, UK
3 Tissue Viability Service, Chelsea & Westminster NHS Hospital Trust, London, UK

Key words
Acute pancreatitis; Laparostomy; Negative
pressure therapy; Open abdomen; Vacuum
dressing
Correspondence to
JEF Fitzgerald, Department of General
Surgery, Chelsea & Westminster NHS
Hospital Trust , 369 Fulham Road, London,
SW10 9NH, UK
E-mail: edwardfitzgerald@doctors.org.uk
Fitzgerald JEF, Gupta S, Masterson S, Sigurdsson, H. Laparostomy management using
the ABThera™ Open Abdomen Negative Pressure Therapy System in a grade IV open
abdomen secondary to acute pancreatitis. Int Wound J 2013; 10:138–144
Abstract
Wound control in laparostomy for the treatment of intra-abdominal hypertension
remains challenging and numerous techniques have been described. We report the
first UK experience with a new commercially available device specifically designed to
facilitate management of the open abdomen. A 44-year-old gentleman presented with a
3-day history of constant severe epigastric pain and associated vomiting. Amylase was
markedly elevated and he was admitted for supportive management of pancreatitis,
with subsequent transfer to intensive care due to severe systemic inflammatory
syndrome. The patient decompensated, developing intra-abdominal hypertension
with renal and respiratory failure. This was successfully managed by performing
a laparostomy and using an ABThera™ Open Abdomen Negative Pressure Therapy
System (KCI, San Antonio, TX). We describe its use to facilitate wound control,
including enteroatmospheric fistula, allowing granulation and eventual restoration of
gastrointestinal continuity 383-days after admission. We found the ABThera™ System
proved to be a useful treatment adjunct, protecting intra-abdominal contents while
removing large volumes of exudate and infected material from within the abdominal
cavity. Complex cases such as this remain infrequent and this article provides a
summary of our experience, including a review of indications for laparostomy and
the underlying basic science in this difficult area.

Introduction retraction of the abdominal wall, control and removal of

significant volumes of exudate or infectious material, and
In recent years, a greater understanding of intra-abdominal
hypertension and abdominal compartment syndrome has led
to the adoption of a variety of surgical and non surgical Key Messages
measures in an attempt to reduce the resulting morbidity
• management of the open abdomen remains a challenge
and mortality associated with these conditions (1,2). The
for surgeons and nursing staff caring for these acutely
mainstay of surgical treatment is the intentional formation
ill patients
of a laparostomy wound, allowing the viscera to expand
• the ultimate aim is closure of the laparostomy, ide-
and so reducing intra-abdominal pressure and associated
ally by early surgical approximation of the fascia, or
complications.
alternatively with secondary healing by granulation and
Management of the resulting open abdomen remains a delayed ventral hernia repair, as appropriate to the
challenge for surgeons and nursing staff caring for these underlying cause and patient condition
acutely ill patients. Loss of fascial domain through lateral
© 2012 The Authors
138 International Wound Journal © 2012 Blackwell Publishing Ltd and Medicalhelplines.com Inc
J. E. Fitzgerald et al.
• the ABThera™ Open Abdomen Negative Pressure Ther-
apy System is a new commercially available device
specifically designed to facilitate management of the
open abdomen where primary closure is not possible or
advisable, or where repeated planned abdominal entries
(‘re-looks’) will be required
• in this paper, we report our experiences with the first use
in the UK of the ABThera™ Open Abdomen Negative
Pressure Therapy System in a patient with acute pan-
creatitis requiring an emergency decompressive laparos-
tomy for intra-abdominal hypertension and associated
renal and respiratory failure
• a 44-year-old gentleman with a previous history of
hypercholesterolaemia, alcohol consumption, gastritis,
hepatitis and hypertension presented following a 3-day
history of constant severe epigastric pain and associated
vomiting
• he was admitted for analgesia and supportive manage-
ment of suspected pancreatitis
• an ongoing systemic inflammatory response syndrome
led to further deterioration with circulatory and type-II
respiratory failure
• a diagnosis of abdominal compartment syndrome sec-
ondary to acute pancreatitis was made and, despite
attempts at instituting conservative treatment measures,
a decompressive laparostomy was required on day 5
• a standard V.A.C.® Abdominal Dressing Kit was
applied over the laparostomy with underlying moist
packs to further protect the bowel
• on day 15, the laparostomy site spontaneously started
bleeding
• exploration of the laparostomy confirmed a clot in the
left paracolic gutter and purulent fluid was drained from
within the peri-pancreatic space before an ABThera™
dressing was reapplied
• on day 34, faeculant material began to discharge through
the abdominal ABThera™ dressing and the pancreatic
drain
• on re-exploration, a perforation found in the descending
colon was sutured
• after a saline washout and the diversion of the localised
source of sepsis from the abdomen the ABThera™
dressing was applied
• on day 86, slow ventilatory weaning was success-
fully completed and ventilatory support was no longer
required
• the patient was stepped down to once-weekly abdomi-
nal wound washouts and changes of the ABThera™ and
GranuFoam™ dressings in theatre
• by day 120, the ABThera™ and left paracolic
GranuFoam™ dressings were removed, with further
care of the residual granulating laparostomy wound bed
undertaken using solely V.A.C.® therapy GranuFoam™
dressings
• on day 126, the patient was sufficiently stabilised to
allow planned discharge to the hospital ward with out-
reach team support
© 2012 The Authors
International Wound Journal © 2012 Blackwell Publishing Ltd and Medicalhelplines.com Inc
Laparostomy management
• after 203 days in hospital, the patient was sufficiently
recovered for transfer to the regional intestinal failure
unit (St. Mark’s Hospital, Harrow, UK) where he under-
went continued nutritional optimisation and radiological
and endoscopic mapping of the remaining bowel and
fistula
• 383 days following his original admission, the patient
underwent restoration of gastrointestinal continuity and
with adhesiolysis, resection of enterocutaneous fistula,
hand-sewn ileo-rectal anatamosis, synthetic mesh repair
of the anterior abdominal wall defect and excision of
midline scar
• the patient went on to make a full recovery with resump-
tion of normal dietary intake
• laparostomy management in acutely ill surgical patients
remains a challenge due to high levels of morbidity and
mortality accompanying the underlying condition
• in this difficult case of severe acute pancreatitis, abdom-
inal compartment syndrome and prolonged grade IV
complex open abdomen, we found that the ABThera™
Open Abdomen Negative Pressure Therapy System was
a useful adjunct to treatment, being easy to use and
effectively sealing and protecting the intra-abdominal
contents whilst removing large volumes of exudate and
infected material from deep within the abdominal cavity
• this ultimately facilitated secondary healing by granu-
lation and eventual restoration of gastrointestinal conti-
nuity
• the successful management of a complex open abdomen
reported here suggests further investigation into the effi-
cacy, and the economics of this new treatment modal-
ity is merited, and a randomised control trial is now
required to facilitate evidence based recommendation
of this new therapeutic device in terms of both clinical
and economic end-points
protection of abdominal viscera all necessitate meticulous,
ongoing post-operative management from an experienced
multidisciplinary team. The ultimate aim is closure of the
laparostomy, ideally by early surgical approximation of the
fascia, or alternatively with secondary healing by granulation
and delayed ventral hernia repair, as appropriate to the
underlying cause and patient condition.
Whilst the abdomen remains open, numerous methods of
temporary abdominal closure have been described, including
towel clipping of skin edges, adhesive drapes, open pack-
ing (3), zipper closures (4), the Wittmann Patch® (Starsurgical
Inc, Burlington, WI) (5,6), synthetic mesh (7,8), various plas-
tic closures (such as the Bogotá Bag, using an empty, opened
intravenous fluid bag) (9) and several different forms of neg-
ative pressure (suction) wound therapy (10). These include
the V.A.C.® Abdominal Dressing System (Kinetic Concepts
Inc, San Antonio, TX) and the ABThera™ Open Abdomen
Negative Pressure Therapy System (Kinetic Concepts Inc).
This latter system is a new commercially available device
specifically designed to facilitate management of the open
abdomen where primary closure is not possible or advis-
able, or where repeated planned abdominal entries (‘re-looks’)
139
Laparostomy management
Figure 1 ABThera™ Open Abdomen Negative Pressure Therapy
System, Courtesy of KCI Licensing, Inc.
will be required. It consists of a non adherent fenestrated
visceral protective layer with foam extensions, and a sep-
arate overlying reticulated open-cell foam dressing, both of
which are sealed under an adhesive plastic drape before con-
necting to a negative pressure therapy unit (Figure 1). It is
designed to isolate and protect abdominal contents from the
external environment, provide medial tension to reduce fas-
cial retraction, remove fluid and infective materials including
from deep within the paracolic gutters, to remove exudate and
reduce oedema, and to allow ease of access for re-entering the
abdomen (11).
In this paper, we report our experiences with the first use in
the UK of the ABThera™ Open Abdomen Negative Pressure
Therapy System in a patient with acute pancreatitis requiring
an emergency decompressive laparostomy for intra-abdominal
hypertension and associated renal and respiratory failure. We
describe the use of the system to facilitate control of an ente-
rocutaneous fistula, and subsequent wound control allowing
secondary granulation and eventual restoration of gastroin-
testinal continuity.
Complex cases such as this remain infrequent outside of
specialist hospital centres and this article provides a summary
of our experience, including a review of indications for
laparostomy and the underlying basic science in this difficult
area. Written informed consent was obtained from the patient
for publication of this case report and accompanying images.
Case report
A 44-year-old gentleman with a previous history of hyperc-
holesterolaemia, alcohol consumption, gastritis, hepatitis and
hypertension presented following a 3-day history of constant
severe epigastric pain and associated vomiting. His initial
serum amylase was elevated at 758 units/l and he was admit-
ted for analgesia and supportive management of suspected
pancreatitis.
Early on the second day he became increasingly tachycardic
and tachypnoeic with cold peripheries and guarding across
the upper abdomen. Aggressive fluid resuscitation continued
and an abdominal CT scan showed a markedly oedematous
pancreas with fluid tracking down both paracolic gutters. The
patient was stabilised and admitted to the high dependency
140 International Wound Journal © 2012 Blackwell Publishing Ltd and Medicalhelplines.com Inc
J. E. Fitzgerald et al.
unit (level 2 care) for acute pancreatitis with a modified
Glasgow criteria of 2 (Calcium 1·9 mmol/L, pO2 7 kPa).
An ongoing systemic inflammatory response syndrome led to
further deterioration with circulatory and type-II respiratory
failure. Marked desaturation and a reduced Glasgow Coma
Score then necessitated urgent intubation and admission to
the intensive care unit (level 3 care).
On day 4, the patient continued to deteriorate with an
increasing intra-abdominal pressure rising to 27 mmHg (mea-
sured intra-vesically), and reduced renal function requiring a
period of continuous veno-venous haemofiltration. A diagno-
sis of abdominal compartment syndrome secondary to acute
pancreatitis was made and, despite attempts at instituting
conservative treatment measures, a decompressive laparos-
tomy was required on day 5. At surgery, a large volume
of straw coloured exudate was drained. The viscera were
markedly oedematous, although well perfused. Following
laparostomy, an immediate reduction in ventilatory airway
pressures occurred and improved oxygenation rapidly fol-
lowed. A nasojejunal feeding tube was also placed for enteral
nutrition.
Initially a standard V.A.C.® Abdominal Dressing was
applied over the laparostomy with underlying moist packs
to further protect the bowel. Post-operatively, there was a
reduction in the intra-abdominal pressure with 500–1000 ml
of fluid draining per day. When the dressing was changed
in theatre four days later, a further 1000–2000 ml of fluid
was found and extracted peri-operatively. An ABThera™
dressing was applied with its limbs extended into the paracolic
gutters and pelvis in an attempt to remove fluid and debris
from this area. Dressing placement is shown in Figures 2–5.
125 mmHg of negative pressure was applied and between
1000 and 2000 ml of serous fluid was drained from the
laparostomy per day.
Figure 2 Initial sizing of the ABThera™ fenestrated visceral protective
layer.
© 2012 The Authors
J. E. Fitzgerald et al.
Figure 3 Placing the ABThera™ fenestrated visceral protective layer
between bowel and abdominal wall.
Figure 4 Sizing and placing the ABThera™ perforated foam over the
fenestrated visceral protective layer.
Figure 5 Connecting the ABThera™ therapy unit to the abdominal
dressings, now sealed under the ABThera™ sealing drape.
In the fortnight following, a tracheostomy was sited for
ventilation and the patient remained persistently pyrexial with
increasing abdominal pain. A repeat abdominal CT identified
© 2012 The Authors
International Wound Journal © 2012 Blackwell Publishing Ltd and Medicalhelplines.com Inc
Laparostomy management
changes in the tail of the pancreas consistent with necrotising
pancreatitis. Upon surgical re-exploration, the nectrotic tissue
was excised from the tail of the pancreas and the patient was
continued on intravenous antibiotics. A sample of necrotic
pancreatic tissue sent for microbiology grew methicillin-
resistant Staphylococcus aureus, and the patient was also
found to be positive for Acinetobacter baumanni. His care
continued with isolation nursing.
On day 15, the laparostomy site spontaneously started
bleeding. A CT angiogram suggested a left paracolic haemor-
rhagic collection, but no evidence of pseudoaneurysm. Explo-
ration of the laparostomy confirmed a clot in the left paracolic
gutter, originating from a tear of the muscularis layer of
the descending colon, which was evacuated. There was no
active bleeding. Purulent fluid was drained from within the
peri-pancreatic space before an ABThera™ dressing was reap-
plied with one limb inserted into the retroperitoneal/pancreatic
space. Twice-weekly re-exploration, washout and dressing
change continued. By this stage, it was apparent that primary
fascial closure would not be clinically appropriate and sec-
ondary granulation with a planned ventral hernia would be
allowed to develop.
On day 34, faeculant material began to discharge through
the abdominal ABThera™ dressing and the pancreatic drain.
On re-exploration, a perforation found in the descending colon
was sutured followed by a saline washout and the insertion of
a left lateral corrugated drain around the repaired site in order
to divert the localised source of sepsis from the abdomen
before reapplying the ABThera™ dressing. A combination
of both the severely disrupted anatomy and intervening time
interval made it difficult to attribute the perforation to the pre-
viously noted tear of the muscularis layer of the descending
colon with certainty, however these were similarly located.
The patient continued to suffer septic episodes, and faecal
material began to drain into the ABThera™ Open Abdomen
Negative Pressure Therapy system again on day 46. Repeat
exploration showed a devascularised and necrotic descending
colon, with faecal contamination concentrated in the left
paracolic gutter. There was inadequate colonic length to
form a defunctioning colostomy so a subtotal colectomy was
performed with the formation of a spouted end ileostomy and
oversewing of the distal rectal stump.
Subsequently, the patient returned to theatre for reapplica-
tion of the ABThera™ dressing and to resuture a dehiscence
of the rectal stump closure. This was followed by repair of
a small bowel fistula arising in a proximal superficial loop
of bowel, which was not in direct contact with ABThera™
dressing.
The oversewn colonic stump continued to leak mucus
discharge into the left paracolic gutter, while the small
bowel fistula recurred despite repeated attempts at careful
oversewing. A decision was made to continue ABThera™
dressings, given the high levels of exudate being removed,
while attempting to compartmentalise the fistula output. To
this end, a V.A.C.® GranuFoam™ (Kinetic Concepts Inc.) was
inserted into the left paracolic gutter and bridged to a further
GranuFoam™ brought out through a fresh 10 cm incision in
the lateral abdominal wall. An ABThera™ dressing was then
re-applied to the laparostomy with the tubing set sited over the
141
Laparostomy management J. E. Fitzgerald et al.

fistula. This succeeded in limiting abdominal contamination

from the small bowel fistula, and significant progress was
made with fresh granulation tissue covering the bowel.
On day 86, slow ventilatory weaning was successfully com-
pleted and ventilatory support was no longer required. The
patient was stepped down to once-weekly abdominal wound
washouts and changes of the ABThera™ and GranuFoam™
dressings in theatre. During this period of recovery, the patient
received regular input from our gastroenterology team regard-
ing management of an effective short bowel syndrome caused
by the proximal small bowel fistula, and total parenteral nutri-
tion was continued with gradual increase in basal oral intake
as fistula output allowed.
Gradual improvement in the patient’s condition contin-
ued; and by day 120, the ABThera™ and left paracolic
GranuFoam™ dressings were removed, with further care of
the residual granulating laparostomy wound bed undertaken Figure 7 GranuFoam™ dressing applied to the residual laparostomy
using solely V.A.C.® therapy GranuFoam™ dressings. Fur- wound bed, excluding the small bowel fistula.
ther dressing changes took place in the intensive care unit
with progressively reducing levels of analgesia required.
(St. Mark’s Hospital, Harrow, UK). There, he underwent con-
On day 126, the patient was sufficiently stabilised to allow
tinued nutritional optimisation and radiological and endo-
planned discharge to the hospital ward with out-reach team
scopic mapping of the remaining bowel and fistula. 383 days
support. He was subsequently briefly readmitted to intensive
following his original admission, the patient underwent
care on day 159 for management of respiratory failure sec-
restoration of gastrointestinal continuity with adhesiolysis,
ondary to Acinetobacter and gram negative Staphylococcus
resection of enterocutaneous fistula, hand-sewn ileo-rectal
chest sepsis, which was treated with antibiotic therapy allow-
anatamosis, synthetic mesh repair of the anterior abdomi-
ing swift return to the hospital ward 7 days later.
nal wall defect and excision of midline scar. Approximately
Over the following weeks intensive nutritional support was
250 cm of small bowel remained, and the patient went on to
accompanied by regular physiotherapy to counter a critical
make a full recovery with resumption of normal dietary intake.
illness myopathy from prolonged bed rest.
By this stage, the negative pressure therapy had achieved
a reduction of the wound bed size to 15 × 9 cm2 with 100% Discussion
tissue granulation (Figure 6). The ileostomy continued to drain
approximately 2000 ml per day with an additional 1000 ml This paper describes our experiences with the first UK use of
from the controlled fistula. Dressing changes using V.A.C.® the ABThera™ Open Abdomen Negative Pressure Therapy
GranuFoam™ lined with Telfa Clear (Kendall, Mansfield, UK) System in a challenging case of severe acute pancreatitis and
were only required once to twice per week, and care was taken grade IV (12) complex open abdomen.
to exclude the small bowel fistula from this (Figure 7). Intra-abdominal hypertension is a frequent finding in
After 203 days in hospital, the patient was sufficiently patients with severe acute pancreatitis requiring admission to
recovered for transfer to the regional intestinal failure unit intensive care, reported in 59–78% of cases (13,14). Abdom-
inal compartment syndrome (defined as intra-abdominal pres-
sure >20 mmHg and ≥1 new organ dysfunction (1)) is associ-
ated with a high mortality of up to 50% (15). Its development
is attributed to a range of contributory factors, including par-
alytic ileus, aggressive fluid resuscitation and retroperitoneal
inflammation, the latter two also causing visceral oedema and
ascites.
Experience of managing the open abdomen generally relates
to trauma or emergency abdominal surgery. While, decom-
pressive laparotomy and resulting laparostomy have been
shown to effectively reduce intra-abdominal pressure and
symptoms of abdominal compartment syndrome (16), the
timing and indicators for this remain an area of ongoing
research. A recent review by De Waele et al. suggests surgical
decompression should be considered in all acute pancreati-
tis patients with intra-abdominal hypertension and persistent
organ dysfunction after 3 days or later (17). In this case, ris-
ing intra-abdominal pressure accompanied by persistent two
Figure 6 Residual laparostomy wound bed. organ failure necessitated a laparostomy on day 5.
© 2012 The Authors
142 International Wound Journal © 2012 Blackwell Publishing Ltd and Medicalhelplines.com Inc
J. E. Fitzgerald et al.
Following formation of a laparostomy, the ideal method of
temporary control should allow rapid closure, easy nursing
maintenance, removal of exudate and infectious material,
protection of the abdominal contents, avoidance of enteric
fistulas, be readily available and cost-effective, and allow
straightforward re-exploration without tissue damage (18). We
found that the ABThera™ Open Abdomen Negative Pressure
Therapy System met these goals and offered a useful treatment
adjunct in the management of this complex case.
In particular, the non adherent fenestrated visceral protec-
tive layer was suited for placement into the paracolic gutters,
where significant fluid collections were not effectively cleared.
Following placement of the ABThera™ System, we saw a
doubling of the daily laparostomy drainage. This correlates
with in vitro experiments showing significantly better negative
pressure distribution in the ABThera™ System compared with
other forms of temporary abdominal closure, together with sig-
nificantly increased rates and volumes of fluid extracted (19).
Although negative pressure wound therapy (also called
‘vacuum therapy’, or ‘vacuum assisted closure’) was first
described over a century ago (20), modern investigation and
application of this technology began in the 1970s, following
the publication of several Russian language studies, suggesting
improved rates of wound healing (21–23). Localised sub-
atmospheric pressure delivered to a wound bed was found
to increase subcutaneous blood flow at an optimal pressure
of −125 mmHg (24). This was associated with a significant
increase in formation of granulation tissue. Although research
findings vary, suggested mechanisms for this include enhanced
capillary circulation and oxygenation through removal of
interstitial fluid (25), reduction in local bacterial loads (26),
and mechanical tissue stress promoting angiogenesis and
new tissue growth (27). It was only as recently as 1995
that vacuum wound therapy techniques were first applied to
managing the open abdomen (10).
Previous studies of vacuum assisted closures in the manage-
ment of wounds (other than laparostomy) have suggested that
these mechanisms translate into clinical and economic bene-
fits with a significantly reduced hospital or community nursing
staff time (28,29), and reduced overall medical costs (30,31).
It remains to be seen whether these findings can be extrapo-
lated to the use of vacuum assisted closures in the management
of abdominal laparostomy wounds. However, with respect to
laparostomy management, significantly higher rates of fas-
cial closure have been shown over a longer postoperative
time period, reducing the morbidity associated with planned
ventral hernia and subsequent need for repair (32). In this clin-
ical case, the development of a devascularised and necrotic
descending colon with faecal contamination meant that early
fascial closure was not appropriate.
Formation of a laparostomy and management of the subse-
quent open abdomen is not without potential complications.
Bleeding from inflamed or traumatised viscera, infection, loss
of bowel function, and decreased central temperature are not
infrequently seen. Lateral retraction of the abdominal wall
over a period of days, together with shrinkage of soft tissue,
can cause what has been termed ‘loss of domain’, preventing
re-approximation of the fascial edges. This, or any remaining
fascial defect despite an attempt at approximation, can lead
© 2012 The Authors
International Wound Journal © 2012 Blackwell Publishing Ltd and Medicalhelplines.com Inc
Laparostomy management
to significant ventral hernia requiring complex delayed repair,
which is frequently a major surgical undertaking.
The most concerning and difficult complication to manage
is that of fistula formation, particularly within the granulating
wound bed. This can lead to infection and abscess forma-
tion, and systemic nutritional compromise. In a systematic
review of small bowel fistulas occurring during treatment of
the open abdomen, clinical studies reported enterocutaneous
fistula rates of 26–50% amongst survivors from acute pancre-
atitis treated with a range of different temporary abdominal
closures (33).
Some concern has been expressed regarding the possibility
that negative pressure wound therapy in the open abdomen
may potentially increase the risk of enterocutaneous fis-
tula, although published literature has not proved an asso-
ciation (34,35). Adverse events may relate to the underlying
disease process, especially in a pro-inflammatory state or with
associated malnourishment, or specific management and tech-
niques including iatrogenic bowel injury. It is acknowledged
that negative pressure foam in direct contact with bowel may
lead to fistula formation. The mechanism underlying this in
such critically ill patients is likely to be mutlifactorial, given
the already high rates of fistula formation even without nega-
tive pressure wound therapy.
In the UK, guidance on the use of negative pressure wound
therapy in the open abdomen from the National Institute
for Clinical Excellence has concluded that there is currently
inadequate quality and quantity of clinical evidence regarding
the efficacy and safety for it to review the procedure, with
further research encouraged (36).
Conclusion
Laparostomy management in acutely ill surgical patients
remains a challenge due to high levels of morbidity and
mortality accompanying the underlying condition. Outside
of specialist centres, cases remain infrequent, and necessary
experience in their complex management may be lacking. The
form of temporary abdominal closure chosen to manage the
laparostomy wound can impact greatly on ease of nursing,
ease of re-exploration, removal of exudate and infectious
material and facilitation of eventual closure, either by primary
approximation of the fascia or by secondary healing as
appropriate.
In this difficult case of severe acute pancreatitis, abdomi-
nal compartment syndrome and prolonged grade IV complex
open abdomen, we found that the ABThera™ Open Abdomen
Negative Pressure Therapy System was an useful adjunct to
treatment, being easy to use and effectively sealing and pro-
tecting the intra-abdominal contents whilst removing large
volumes of exudate and infected material from deep within the
abdominal cavity. This ultimately facilitated secondary heal-
ing by granulation and eventual restoration of gastrointestinal
continuity.
The successful management of a complex open abdomen
reported here suggests further investigation into the effi-
cacy, and the economics of this new treatment modality is
merited, and a randomised control trial is now required
to facilitate evidence-based recommendation of this new
143
Laparostomy management
therapeutic device in terms of both clinical and economic
end-points.
Acknowledgements
Figure 1 ABThera™ Open Abdomen Negative Pressure Ther-
apy System, Courtesy of KCI Licensing, Inc. J. E. F. F. has
received speaker fees for the presentation of this case since
the manuscript was prepared from Kinetic Concepts Inc.
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© 2012 The Authors