Complications of damage-control abdominal surgery: What you need to know.

The open abdomen is a heroic surgical technique used in trauma, emergency general surgery, and vascular emergencies. Much has been written about the surgical technique, indications, management, temporizing abdominal closure, and final primary fascial closure. As with all surgical procedures, the open abdomen has associated morbidity and mortality. Complications with the open abdomen will present at different times based on the time from the index operation. We review the most common complications associated with the open abdomen, categorized by the time elapsed since the abdomen was initially opened. These range from fluid loss and electrolyte loss to the need for mechanical ventilation and nutrition support in the early course. During the midcourse, one can see the loss of domain, intra-abdominal infections, and other hospital-acquired infections. The exposed viscera are at risk of injury and anastomotic leaks, resulting in enteroatmospheric fistulas. The late course is commonly characterized by the struggle to achieve primary fascial or skin closure to protect the viscera or to decide on a planned ventral hernia. This surgical bailout technique has specific aspects that must be followed to achieve clinical success.