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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