%0 Journal Article
%T Transverse laparostomy is feasible and effective in the treatment of abdominal compartment syndrome in severe acute pancreatitis
%A Ari Lepp£¿niemi
%A Panu Mentula
%A Piia Hienonen
%A Esko Kemppainen
%J World Journal of Emergency Surgery
%D 2008
%I BioMed Central
%R 10.1186/1749-7922-3-6
%X A patient with SAP developed manifest ACS and was treated with bilateral subcostal laparostomy. Immediately after decompression, the intra-abdominal pressure dropped from 23 mmHg to 10 mmHg, and the respiratory, cardiovascular and renal functions improved markedly leading to full recovery. The abdominal incision including the fascia and the skin was closed gradually over 4 relaparotomies, and during the 6 months' follow up there are no signs of ventral hernia or other wound complications.Transverse subcostal laparostomy is a promising alternative decompression technique for ACS in SAP. It is feasible, effective and might provide a chance of early fascial closure. Comparative studies are needed to define its role as a decompressive technique for ACS.Abdominal Compartment Syndrome (ACS) is defined as a state of serious organ dysfunction resulting from sustained increase in intra-abdominal pressure (IAP), that most obviously affects the cardiovascular, respiratory and renal systems [1]. Recently it has been suggested that some patients with severe acute pancreatitis (SAP) who develop early Multiple Organ Dysfunction Syndrome (MODS) in effect suffer from ACS caused by massive fluid resuscitation, capillary leak and visceral edema [2-7]. Although percutaneous drainage of ascites can in some cases decrease IAP at least temporarily, surgical decompression, most commonly performed through a long vertical midline incision leaving the abdomen open and covered with a negative abdominal pressure dressing, is the preferred method of treatment [8]. However, a literature analysis of 18 studies with 250 patients with ACS showed that although decompression has a significant effect in lowering IAP, mortality still remains considerable and little is known on its effect on organ dysfunction, highlighting the importance of careful consideration before surgical intervention [9]. In some cases, the poor response might be due to an intervention performed too late, but until more data is av
%U http://www.wjes.org/content/3/1/6