Surgical management of abdominal compartment syndrome

Background. The majority of intensive care physicians recognize the clinical significance of intra-abdominal hypertension on the outcome of critically ill patients. Abdominal compartment syndrome (ACS) is defined as an intra-abdominal pressure (IAP) >20 mmHg with ongoing organ failure. However, there is no consensus regarding the indications for surgical decompression. Methods. A review of personal data and the English literature from 1989 to 2010 focusing on surgical management of ACS. Results. Opening the abdomen is the most effective method to reduce IAP and is the treatment of choice for ACS when TAP is constantly higher than 30 mmHg with ongoing organ failure refractory to medical therapy. A vertical midline incision is the most popular method of surgical decompression, but bilateral subcostal incisions may be indicated in certain conditions. Surgical decompression always obtains a significant decrease in the TAP with physiological improvement, but the effects on organ function are controversial. Negative pressure devices are the most effective for temporary abdominal closure with a higher rate of primary fascial closure and lower risk of fistulas. When primary fascial closure is not feasible, a planned ventral hernia and spontaneous granulation with or without biologic mesh are the preferred methods for the reconstruction of abdominal wall integrity. Conclusion. Modern surgical techniques for opening the abdomen in patients with ACS refractory to medical therapy result in physiologic improvement with less treatment-related complications, but recuperation of organ dysfunction is variable. (Minerva Anestesiol 2011;77:457-62)