Laparostomy is a damage control strategy used in abdominal compartment syndrome (ACS) to prevent early death. However, once the acute episode is controlled, the closure of the open abdomen can be difficult or even impossible [1Lambertz A., e al. Fascial closure after open abdomen: initial indication and early revisions are decisive factors–a retrospective cohort study Int. J. Surg. Lond. Engl. 2015 ;  13 : 12-16

Cliccare qui per andare alla sezione Riferimenti]. Opening of the abdominal cavity has deleterious effect, it increases the protein loss and the hypercatabolism. On the long term, lack of parietal closure can lead to consequences such as giant incisionnal hernia or eviscerations. Extended length of the laparostomia, muscular retraction, digestive stomias and cutaneo-muquous oedema are obstacles to a complete parietal closure. Use of vacuum-assisted wound therapy (VAC therapy) could increase the rate of parietal closure. Biologic meshes have the advantage prevent septic complications for that reason they can be use in a septic context [2Nahabedian M.Y., Sosin M., Bhanot P A Current Review of Biologic Meshes in Abdominal Wall Reconstruction Plast. Reconstr. Surg. 2018 ;  142 : 74S-81S

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This video aim is to suggest a protocol of laparostomy's closure combining fluid depletion by hemodialysis, sequential parietal closure, VAC therapy and use of biologic mesh in an intraperitoneal position.

This video describes the management of a 68-year-old woman who has presented an ACS associated with intestinal ischemia after a septic shock on a perforated duodena ulcer. The initial medico-surgical management of the ACS led to a decrease of the intra-abdominal pressure (IAP) at the expense of a xipho-pubic laparotomy treated with a VAC therapy and two double barreled ileostomy and colostomy. A Day 7, the patient was clinically stabilized. Yet, there were multiple bad prognosis factors of complete abdominal closure: a ten centimeters abdominal defect, two complex stomas with very thin skin bridges, a massive edema and a laparostomy open for more than 7 days. We describe in this video a medico-surgical strategy aiming to obtain a complete abdominal and skin closure after an open abdomen.

The first step was dialysis in the intensive care unit to increase the elasticity of the tissues. Then, the abdominal cavity and the skin were closed sequentially 3 times at the operating theater between day 7 and day 13. The vacuum- assisted wound closure therapy was pursued all along. During the last surgery at day 13, an intraperitoneal biologic mesh was placed using a bridging repair to obtain a complete abdominal closure. 6 months later after closure of the ileostomy, patient has no sequala despite an asymptomatic incisional hernia, which is an expected sequella after bridging repair with an intraperitoneal biologic mesh [3Taibi A., e al. Implantation of biologic mesh in ventral hernia repair-does it make sense? Surg. Endosc. 2021 ;  35 : 702-709

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In conclusion, this strategy allows a complete abdominal closure and avoids a skin-only closure.