Clinical Scorecard: Guidelines for Managing Complex Abdominal Wall Issues: Insights from the Italian Consensus Conference

At a Glance

Key Highlights

• Open abdomen (OA) technique is increasingly used for damage control in life-threatening abdominal conditions.
• Complex abdominal wall defined by high risk of compartment syndrome, suture dehiscence, and need for early reoperation.
• Patient and surgical risk factors influence abdominal wall closure outcomes; no universal consensus yet on defining complexity.

Guideline-Based Recommendations

Diagnosis

• Define complex abdomen by presence of high risk for compartment syndrome, suture dehiscence, or early re-do laparotomy (strong recommendation).
• Use multifactor scoring systems (e.g., VAMC score, Rotterdam score) to assess risk of abdominal wall suture complications.

Management

• Employ open abdomen technique in emergency and elective cases where indicated by patient and disease risk factors.
• Consider temporary abdominal closure techniques tailored to patient condition and surgical context.
• Use biological and synthetic meshes appropriately with follow-up to optimize outcomes.

Monitoring & Follow-up

• Monitor for complications related to open abdomen such as infection, fistula formation, and abdominal wall dehiscence.
• Follow-up patients with biological or synthetic mesh implants to assess for recurrence or complications.

Risks

• Recognize risks associated with open abdomen including serious complications despite life-saving benefits.
• Identify patient risk factors such as age >70, obesity, smoking, steroid or cytostatic use, diabetes, malnutrition, ASA III-IV, vascular disease, constipation, ascites, BPCO, sepsis, and previous laparotomies.
• Consider disease and surgical risk factors including abdominal trauma, ruptured viscera, and peritonitis.

Patient & Prescribing Data

Patients undergoing complex abdominal surgery with risk factors for abdominal wall complications

Treatment involves decision-making on abdominal wall closure techniques, use of open abdomen, and mesh application based on individual risk profiles and surgical context.

Clinical Best Practices

• Adopt a homogeneous, evidence-based approach to defining and managing complex abdominal wall conditions.
• Utilize multidisciplinary consensus and grading of recommendations to guide surgical decision-making.
• Incorporate comprehensive literature review and validated scoring systems to stratify patient risk and tailor interventions.

References

• Italian Consensus Conference on Complex Abdominal Wall Management