Carlos Manterola; Josue Rivadeneira; Juan Pablo Holguín; María Fernanda García & Georgina Muñoz

The open abdomen (OA) is a technical innovation that has enhanced the surgical understanding of damage control surgery (DCS), temporary abdominal closure, staged abdominal reconstruction, visceral care, and abdominal wall reconstruction. The aim of this study was to report the existing evidence on the use of OA in patients with intra-abdominal hypertension (IAH), abdominal compartment syndrome (ACS), DCS for trauma, and the prevention and treatment of IAH and ACS. An overview was conducted. Primary or secondary articles evaluating the outcomes of OA in adults, for septic or traumatic indications, published between 2010 and 2023 were considered. The following meta-search engines, libraries, and databases were reviewed: Trip Database, BIREME-BVS, SciELO, Cochrane Central Register of Controlled Trials, WoS, MEDLINE, EMBASE, and SCOPUS. Risk of bias assessment was applied using the SIGN design. Subsequently, the levels of evidence were classified according to the Oxford CEBM proposal. Methodological quality (MQ) was determined using AMSTAR 2 for systematic reviews (SR), modified Jadad for clinical trials (CT), and MInCir-T for observational studies (OS) and therapy- related CT. Finally, the evidence was graded using the GRADE system. A total of 33 studies were analyzed (9 SR, 3 CT, and 21 OS, representing a population of 26,519 patients with O A). In subjects with OA due to IAH, the evidence regarding morbidity and mortality is scarce and heterogeneous. In adults with abdominal trauma and OA, better outcomes are observed when negative pressure closure techniques are applied compared to passive temporary closure. The existing evidence to recommend commercial devices over homemade devices is weak. Systematic and routine measurement of intra- abdominal pressure would be justified as a method for detecting IAH and ACS in patients with OA due to IAH or trauma. The available evidence regarding the effectiveness of OA techniques in patients with trauma and IAH in the presented situations is based on a few studies, mostly of low MQ. Therefore, new high-quality comparative studies with an adequate number of patients are needed to clarify the current uncertainty.

MANTEROLA, C.; RIVADENEIRA, J.; HOLGUÍN, J.P.; GARCÍA, M.F. & MUÑOZ, G. Open abdomen. Overall review of the evidence. Int. J.Morphol., 43(1):275-293, 2025.