Open Abdomen — Temporary Abdominal Closure

Open abdomen (laparostomy) is a damage-control surgical strategy in which the fascia is intentionally left open after laparotomy to manage intra-abdominal hypertension, prevent abdominal compartment syndrome, allow planned re-exploration, or contain massive contamination. Temporary abdominal closure (TAC) protects the viscera, controls fluid losses, and prepares the patient for definitive fascial closure.

Indications include severe trauma with the lethal triad of acidosis, hypothermia, and coagulopathy; abdominal compartment syndrome; severe peritonitis or pancreatic necrosis; mesenteric ischemia; and inability to close the fascia without tension. Negative-pressure wound therapy (NPWT) systems such as ABThera and Bogota bag have replaced older techniques and reduce visceral adhesions and fistula formation.

Goals are early definitive closure, ideally within seven to ten days, to minimize the risk of frozen abdomen, enteroatmospheric fistula, and ventral hernia. Components separation, biologic mesh, dynamic suture systems, and sequential abdominal closure techniques aid late closure. Open abdomen is associated with high mortality and morbidity, requiring multidisciplinary critical-care expertise.