Delayed abdominal closure in the management of ruptured abdominal aortic aneurysms

Background Resuscitative measures associated with ruptured abdominal aortic aneurysm (rAAA) repair may result in massive edema of the bowel, retroperitoneum and abdominal wall. The resulting “abdominal compartment syndrome” may compromise abdominal closure and may be associated with respiratory, renal and cardiovascular deterioration. Methods The medical records of 23 patients surviving initial operative repair of a rAAA were retrospectively reviewed. Eight underwent delayed abdominal closure after early approximation with silastic sheets (n = 6) or of the skin only (n - 2). Ultimate outcome, as well as several pulmonary and cardiovascular parameters, were compared with patients undergoing standard primary fascial closure (n = 15). Results A trend toward improved survival was apparent in the group undergoing delayed abdominal wall closure. Significant improvements in oxygenation and mixed venous oxygen saturation were observed in these patients, and there were fewer late deaths due to multiple organ failure. No patient undergoing delayed abdominal closure developed a graft infection. Conclusions As in massively resuscitated trauma victims, delayed laparotomy closure in rAAA patients may confer a physiologic and survival benefit.