Immediate closure of the open abdomen with bilateral bipedicle anterior abdominal skin flaps and subsequent retrorectus prosthetic mesh repair of the late giant ventral hernias

Background. Management of the open abdomen in trauma and nontrauma patients is difficult, and some areas of controversy remain. Gastrointestinal fistulas are serious complications that are associated with significant mortality. We present our method for management of patients with open abdomen and also present a logical technique of subsequent repair of the late giant ventral hernias that uniformly occur in these patients. Methods: From January 1992 to December 2001, nine patients with open abdomen underwent successful immediate closure with bilateral bipedicle anterior abdominal skin flaps. The major points of this technique of abdominal closure are coverage of abdominal viscera with absorbable mesh and mobilization of the skin and subcutaneous tissue on both sides of the abdominal wound to cover the absorbable mesh. All patients had uneventful recovery and also had subsequent late giant ventral hernias. Repair of the late giant ventral hernias was performed several months later by inserting a large sheet of nonabsorbable mesh under the rectus abdominis muscles that form the neck of the ventral hernia bilaterally. This technique of ventral hernia repair is also called retrorectus prosthetic mesh repair. Results: Five men and four women were entered into the study. The age ranged from 22 to 53 years (median, 35 years). Seven patients suffered from blunt and penetrating trauma and two patients suffered from nontrauma causes. All patients with immediate closure of the open abdomen had uneventful recovery. Late giant ventral hernias (diameter, > 10 cm) occurred in all patients. The time from closure of the open abdomen to subsequent repair of the giant ventral hernias ranged from 7 to 48 months (median, 14 months). Follow-up after hernia repair ranged from I to 72 months (median, 9 months), and we have seen no evidence of recurrence. Conclusion: Immediate closure of the open abdomen with bilateral bipedicle anterior abdominal skin flaps is an effective technique for dealing with such potentially complicated problems. Management of late giant ventral hernias with retrorectus prosthetic mesh repair is theoretically reasonable and, so far, no recurrence has been observed in our patients.