Which Is the Optimal Technique for Temporary Abdominal Coverage?

We read with interest the article by Mayberry et al¹ in the September 1997 issue of the ARCHIVES on prevention of abdominal compartment syndrome by absorbable mesh prosthesis closure. In their group of 73 trauma victims undergoing temporary abdominal coverage, postoperative complications included the occurence of bowel fistulas and incisional hernias in 34 and 27 instances, respectively. Mesh placed directly over the viscera can cause bowel erosions at reexploration with resulting enteric fistulas or may cause adhesions, making its removal difficult.^2- 3 Recently, 3 of our articles^2- 4 dealing with temporary abdominal coverage in patients with delayed generalized peritonitis were published in the literature. The common principle among the techniques described is the insertion of an inert polyethylene foil screen beneath the laparostomy coverage to avoid its direct contact with the viscera. A total of 79 patients from these 3 studies underwent 438 reexplorations (mean, 5.4 reexplorations per patient) and no intestinal fistulas occurred. We were able to perform direct fascial closure in all 63 survivors and during a cumulative mean follow-up of 23.7 months there were no postoperative hernias.