Strategies for modulating the inflammatory response after decompression from abdominal compartment syndrome

A review of the relevant English language literature was conducted. Priority was placed on articles published within the last 5 years.Recent data from our group and others have begun to lay the foundation for the concept of TAC as a method to modulate the local and/or systemic inflammatory response in patients with an open abdomen resulting from ACS.Management of the open abdomen is an increasingly common part of modern surgical practice. Common clinical situations that mandate the use of temporary abdominal closure (TAC) include intra-abdominal hypertension (IAH) with new organ dysfunction (abdominal compartment syndrome (ACS)), intra-abdominal sepsis without adequate source control, damage control in trauma, and mesenteric ischemia [1]. While it is difficult to estimate the prevalence or economic impact of the open abdomen, it is associated with significant issues contributing to morbidity and mortality, including development of ventral hernias, enteroatmospheric fistulas, and un-intentional protein loss [2].The focus of this review is to detail current thoughts on the use of TAC in the management of the open abdomen, with particular attention to decompression after ACS. We review the relevant intra-abdominal related pathophysiology involved with ACS (with emphasis on the gut), the different types of TAC and evidence to support various choices. Recent data from our group and others have begun to lay the foundation for the concept of TAC as a method to modulate the local and/or systemic inflammatory response after ACS.As defined by the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome (World Society of the Abdominal Compartment Syndrome, http://www.wsacs.org webcite), ACS is defined as IAH (increased intra-abdominal pressure (IAP) (> 20 mmHg)) leading to new organ dysfunction/failure [3,4]. In general, there is improvement in organ function after decompressive laparotomy. ACS can be subdivided into primary, secon