Table 1 Advantages and disadvantages of different types of temporary abdominal closure (TAC) techniques
From: The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper
Technique | Equipment | Advantages | Disadvantages |
|---|---|---|---|
Skin only closure | Skin staples, towel clips or sutures | Cheap, available, minimises heat and fluid loss | Damage to the skin, risk of evisceration, no control of fluid loss, incidence of ACS |
‘Bogota’ bag | Sterile 3 litre Saline bag cut and shaped and sutured to fascial edges | Cheap, available, minimises heat and fluid loss | Damage to the fascial edges, risk of evisceration, no control of fluid loss. Allows some assessment of intestinal viability. |
Opsite Sandwich technique | Polyethylene sheet, Opsite dressings, abdominal packs, 2 suction drains and wall suction. | Cheap, available, minimises heat and fluid loss is controlled and measurable | Incomplete fluid control and need for available wall suction. |
Absorbable mesh | Vicryl or similar MESH | Absorbable mesh, infection resistance, protects from evisceration, can be skin grafted. | High rate of subsequent incisional herniation |
Non-absorbable mesh or commercial ‘Zipper’ | Commerical Whittman patch | Abdominal re-exploration is easy, maintains abdominal domain, gradual abdominal closure possible | Commercial equipment required and multiple trips to the operating theatre usually required for closure. |
Vacuum Assisted Closure (VAC) | Commercial equipment | Prevents loss of abdominal domain, collects and monitors fluid loss, decreases ACS, no damage to skin or abdominal fascia. | Expensive commercial equipment required. Usually requires GA to change VAC system |