Clinical Report: Italian Consensus on Managing Complex Abdominal Wall Issues
Overview
The Italian Consensus Conference established evidence-based recommendations for defining and managing complex abdominal wall conditions, particularly focusing on the use of open abdomen (OA) techniques in emergency and elective surgery. The guidelines address indications, surgical techniques, temporary abdominal closure methods, and mesh use to improve patient outcomes.
Background
The open abdomen (OA) technique has become increasingly common in managing life-threatening abdominal conditions such as intra-abdominal hypertension, abdominal compartment syndrome, and severe sepsis. Despite its life-saving benefits, OA is associated with significant complications, necessitating standardized management approaches. Prior to this consensus, there was no unified definition or guidelines for complex abdominal wall management in both emergency and elective settings. The Italian Consensus Conference aimed to fill this gap by developing recommendations based on clinical evidence.
Data Highlights
Key patient risk factors identified for complex abdominal wall closure complications include age over 70, obesity, smoking, steroid or cytostatic use, diabetes, malnutrition, ASA III-IV status, vascular disease, constipation, ascites, chronic obstructive pulmonary disease, prolonged hospital stay, sepsis, and previous laparotomies. Disease and surgical risk factors include abdominal trauma and ruptured viscera. Multifactor scoring systems such as the VAMC and Rotterdam scores have been proposed to predict suture complications.
Key Findings
A complex abdomen in emergency surgery is defined by a high risk of compartment syndrome, suture dehiscence, or need for early reoperation (strong recommendation).
Patient-related risk factors for abdominal wall complications include advanced age, obesity, smoking, immunosuppression, diabetes, malnutrition, and severe systemic illness.
Disease and surgical factors such as abdominal trauma, ruptured viscera, peritonitis, and bowel obstruction increase complexity.
There is no universal consensus on the best surgical closure technique for complex abdominal walls, highlighting the need for individualized approaches.
Temporary abdominal closure techniques and the use of biological or synthetic meshes require careful selection based on contamination and patient factors.
The consensus process involved multidisciplinary experts and used systematic literature review and grading of evidence to formulate recommendations.
Clinical Implications
Clinicians should assess patient and disease-specific risk factors when planning abdominal wall closure, recognizing situations that warrant open abdomen management. Adoption of standardized definitions and scoring systems can aid in risk stratification and surgical decision-making. Selection of temporary closure techniques and mesh materials should be tailored to minimize complications and optimize outcomes.
Conclusion
The Italian Consensus Conference provides a structured framework for defining and managing complex abdominal wall conditions, promoting evidence-based practices to improve surgical outcomes in both emergency and elective settings.
References
Italian Consensus Conference 2015 -- Guidelines for Managing Complex Abdominal Wall Issues
