Staged Abdominal Repair in Critical Illness

Abstract

Marlex mesh interposition as part of staged abdominal repair (M-STAR) was used on 68 occasions to reduce pressure during abdominal closure (46), facilitate multiple laparotomies (15), both indications (4) or defect repair (3), in 66 critical care admissions (median \APACHE-II=21). Physiological data before and after M-STAR performed for intra-abdominal pressure were retrospectively available on 33/36 ventilated occasions. Compliance improved (median Vt/[Paw-PEEP] 22.6 vs 30.3 ml/cm H2O, P<0.0001), but efficiency of oxygenation (median PaO2/FiO2 136 vs 175 mmHg) and ventilation (median VE/PaCO2 243 vs 289 ml/min/mmHg) were unchanged. Heart rate fell (median 130 to 110, P=0.01), blood pressure and inotrope dose did not change. Urine flow increased (median 60 to 110 ml/h, P=0.007) but there was no clear trend in six-hourly serum creatinine. Seven bowel fistulae and three dehiscences occurred. Thirty-five patients survived critical care after 2–7 (median 2) M-STAR related operations and 3–63 (median 20) days. Thirty-one hospital survivors used 19–158 (median 47) hospital days; one patient was still in hospital at 39 months. Five patients died 1–55 months after hospital discharge. At follow-up 1–39 (median 7.5) months after critical care there were two fistulae, five stitch sinuses and five incisional hernias in the 27 survivors. M-STAR facilitates critical care and repeat laparotomy with acceptable surgical sequelae.