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

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Abstract

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.

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Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgments

Thanking the Lugo University Hospital, especially Dr. Gejundez and Dr. Conde for their cooperation and kindness.

Funding

We have no funding.

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Authors and Affiliations

  1. Unit of HPB Surgery and Abdominal Organ Transplantation, Department of Surgery, Faculty of Medicine, Instituto de Investigación (imas12), Complutense University, Madrid, Spain

    I. Justo, A. Marcacuzco, Ó. Caso, A. Manrique, Á. García-Sesma, J. Calvo, C. Fernández, V. Vega & C. Jiménez-Romero

  2. Service of Thoracic Surgery and Lung Transplantation, Salamanca University Hospital, Salamanca, Spain

    C. Rivas

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Contributions

All authors approved the submitted manuscript and have made important contributions to this research. Iago Justo, Carlos Jiménez-Romero, and Cristina Rivas: writing the article; Iago Justo, Carlos Jiménez-Romero, Cristina Rivas, Oscar Caso, Alberto Marcacuzco: study design, interpretation, drafting, and critical review of the article; Iago Justo, Carlos Jiménez-Romero, Viviana Vega, Alberto Marcacuzco, Alejandro Manrique, Clara Fernández, Jorge Calvo Pulido, and Alvaro García-Sesma: data collection, and data analysis.

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Correspondence to I. Justo.

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The Ethics Committee of the “Doce de Octubre” University Hospital waived approval due to the retrospective nature of the study.

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Justo, I., Marcacuzco, A., Caso, Ó. et al. Modified Chevrel technique for abdominal closure in critically ill patients with abdominal hypertension and limited options for closure. Hernia 27, 677–685 (2023). https://doi.org/10.1007/s10029-023-02797-w

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  • DOI: https://doi.org/10.1007/s10029-023-02797-w

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