RT Journal
A1 Losanoff JE, Richman BW, Jones JW
T1 TEmporary abdominal coverage and abdominal compartment syndrome
JF Archives of Surgery
JO Archives of Surgery
YR 2003
FD May 1
VO 138
IS 5
SP 565
OP 565
DO 10.1001/archsurg.138.5.565-a
UL http://dx.doi.org/10.1001/archsurg.138.5.565-a
AB 
Gracias et al concluded that TAC did not prevent the recurrence of ACS and the associated high mortality but did not go on to describe the etiology suggested by the abnormalities found at reexploration. Abdominal compartment syndrome could have resulted from ongoing intra-abdominal bleeding, extensive packing, or expanding retroperitoneal hematomas,2 but undersized TACs could also have constricted expansion, thereby promoting increased intra-abdominal pressure. The ability of the vacuum TAC to contain the expanding viscera while keeping intra-abdominal pressure low is questionable in this series, considering the high recurrence rate. The article did not include data about the expansion capacity of vacuum-pack TACs in comparison with other recently reviewed TAC systems,2 some of which use redundant coverage to facilitate expansion of the abdominal cavity, as in progressively distending bowel. Furthermore, vacuum closure requires a surgical towel to be placed between the closure's plastic drapes, obscuring dynamic visual assessment of the viscera and impeding early recognition of such complications as intra-abdominal bleeding or anastomotic disruption.