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Savino Occhionorelli [1] and Monica Zese [1] and Rosario Cultrera [2] and Domenico Lacavalla [1] and Marco Albanese [1] and Giorgio Vasquez [3]

Academic Editor: Gianluca Pellino

1, Department of Morphology, Surgery and Experimental Medicine-University of Ferrara and Sant’Anna University Hospital of Ferrara, Ferrara, Italy, unife.it

2, Department of Medical Sciences, Centre for International Cooperation and Development, Infectious Diseases Unit-University of Ferrara and Sant’Anna University Hospital of Ferrara, Ferrara, Italy, unife.it

3, Department of Surgery, Emergency Surgery Service, Sant’Anna University Hospital, Ferrara, Italy, unife.it

Received May 21, 2017; Revised Oct 16, 2017; Accepted Oct 17, 2017

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Introduction

The open abdomen (OA) technique or laparostomy is a surgical option nowadays considered acceptable for the treatment of critically ill patients [1–3]. The key idea is to leave the abdominal cavity open in order to reduce the intra-abdominal pressure in case of abdominal hypertension and/or to allow a better control of the abdominal cavity in case of intra-abdominal infections. Abdominal contents are exposed; thus, they need to be protected with a temporary abdominal closure (TAC) [4]. Several TAC systems are used nowadays [5–8]. Usually, the role of laparostomy is closely linked to damage control surgery, especially in traumatized patients [9]. It can also be adapted in advanced sepsis or in the emergency treatment of acute peritonitis [4, 5, 10–14], in order to prevent or control the frame of septic shock [13, 15]. On this topic, the literature is still being debated nowadays [3, 11]. Fascial closure can be realized <7 days (early) or >7 days (delayed) after the initial OA procedure [5]. The gold standard is the early fascial closure [5, 16–46], in order to reduce complications, but in septic patients, it is less likely to be achieved. Anyway, it should be performed as soon as possible, when abdominal sepsis is under control [5, 17–19]. It is widely reported in the literature that the maintenance of OA predisposes patients to a further microbial and fungal contamination [20]. Therefore, antibiotic and antifungal therapies have an important role for controlling the source of sepsis and the risk of complications...

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