Modified Chevrel technique for abdominal closure in critically ill patients with abdominal hypertension and limited options for closure

• Published in: Hernia : the journal of hernias and abdominal wall surgery Vol. 27; no. 3; pp. 677 - 685
• Main Authors: Justo, I., Marcacuzco, A., Caso, Ó., Manrique, A., García-Sesma, Á., Calvo, J., Fernández, C., Vega, V., Rivas, C., Jiménez-Romero, C.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01-06-2023; Springer Nature B.V
• Subjects: Abdomen; Abdominal Surgery; Abdominal wall; Abdominal Wall - surgery; Abdominal Wound Closure Techniques; Acute Disease; Critical Illness; Female; Hernia; Herniorrhaphy; Humans; Hypertension; Ischemia; Laparotomy; Laparotomy - adverse effects; Male; Medicine; Medicine & Public Health; Original Article; Pancreatitis; Pancreatitis - etiology; Pancreatitis - surgery; Surgical Mesh; Thrombosis; Abdominal hypertension; Abdominal wall closure; Modified Chevrel technique; Pancreatitis
• ISSN: 1248-9204; 1265-4906; 1248-9204
• DOI: 10.1007/s10029-023-02797-w

Abdominal compartment syndrome is a potentially life-threatening condition seen in critically ill patients, and most often caused by acute pancreatitis, postoperative abdominal vascular thrombosis or mesenteric ischemia. A decompressive laparotomy is sometimes required, often resulting in hernias, and subsequent definitive wall closure is challenging.
Aim
This study aims to describe short term results after a modified Chevrel technique for midline laparotomies in patients witch abdominal hypertension.
Materials and methods
We performed a modified Chevrel as an abdominal closure technique in 9 patients between January 2016 and January 2022. All patients presented varying degrees of abdominal hypertension.
Results
Nine patients were treated with new technique (6 male and 3 female), all of whom had conditions that precluded unfolding the contralateral side as a means for closure. The reasons for this were diverse, including presence of ileostomies, intraabdominal drainages, Kher tubes or an inverted T scar from previous transplant. The use of mesh was initially dismissed in 8 of the patients (88,9%) because they required subsequent abdominal surgeries or active infection. None of the patients developed a hernia, although two died 6 months after the procedure. Only one patient developed bulging. A decrease in intrabdominal pressure was achieved in all patients.
Conclusion
The modified Chevrel technique can be used as a closure option for midline laparotomies in cases where the entire abdominal wall cannot be used.