Keywords : SURGICAL
Basrah Journal of Surgery,
2009, Volume 15, Issue 2, Pages 16-19
Open abdomen is a concept that the abdomen is left open after laparotomy especially when it
was done as emergency for traumatic abdomen or reopens the abdomen when signs of
increase intra-abdominal pressure (IAP) causing abdominal compartment syndrome (ACS).
This open abdomen must be covered temporarily till the signs of abdominal compartment
syndrome (ACS) disappears and intra-abdominal pressure (IAP) returns normal, then reclose
the abdomen by one of definitive procedure.
It was found that Vacuum-assisted wound closure (VAWC) is the best temporary procedure to
close the abdomen to get early or late fascial closure as the best definitive closure of open
Also It was found that the classification of open abdomen is so helpful in choosing the
procedure for temporary and definitive closure, this classification is new thing and dependable.
Basrah Journal of Surgery,
2009, Volume 15, Issue 2, Pages 10-15
Despite important advances in surgical care and minimized surgical trauma, postoperative
complications are still of great concern. Nutritional depletion has been demonstrated to be a
major determinant in the development of postoperative complications. Nutritional status of
gastrointestinal surgical patients is an important issue, which need to be attended in particularly
during the perioperative period.
Fears of postoperative ileus and the integrity of the newly constructed anastomosis have led to
the adoption of starvation with administration of intravenous fluids until the return of normal
bowel sounds and passage of flatus. However, it has been shown that early postoperative
enteral feeding is both beneficial and well-tolerated.
Meta-analysis has shown that enteral feeding compared with parenteral nutrition is associated
with fewer complications, reduced costs and a shorter hospital stay. Therefore it should be the
preferred option whenever possible.
Evidence to support preoperative nutrition is limited, but malnourished individuals fed for 7-10
days preoperatively may have improved surgical outcome.
Prolong preoperative starvation is not essential, and the administration of preoperative
carbohydrates is safe without the fear of increasing the risk of aspiration.
Initially nutritional support was aimed at meeting the energy needs and providing proteins and
other essential micronutrients, while now it is more directed at modulation of the immune
functions, the so called immunonutrition.
Multimodal strategies including minimal invasive surgery, adequate postoperative analgesia,
nutritional care, and enforced mobilization resulted in reduction in postoperative complications
and length of hospital stay.