?? Paper of the day

Published in: World Journal of Gastrointestinal Surgery

Narrative Review:

Surgical decompression for the management of abdominal compartment syndrome with severe acute pancreatitis [DOI:?10.4240/wjgs.v15.i9.1879 ]

https://www.wjgnet.com/1948-9366/full/v15/i9/1879.htm

Summary:

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) play a pivotal role in the pathophysiology of severe acute pancreatitis (SAP) and contribute to new-onset and persistent organ failure.

The optimal management of ACS involves a multi-disciplinary approach, from its early recognition to measures aiming at an urgent reduction of intra-abdominal pressure (IAP). A targeted literature search from January 1, 2000, to November 30, 2022, revealed 20 studies and data was analyzed on the type and country of the study, patient demographics, IAP, type and timing of surgical procedure performed, post-operative wound management, and outcomes of patients with ACS.

This narrative review focuses on the current evidence regarding surgical decompression techniques for managing ACS in patients with SAP.

?? Takeaways:

1??There was no randomized controlled trial published on the topic. There is a lack of high-quality evidence on patient selection, timing, and modality of surgical decompression.

2?? Decompressive laparotomy is effective in rapidly reducing IAP (standardized mean difference = 2.68, 95% confidence interval: 1.19-1.47, P < 0.001; 4 studies).

3??Disease-specific patient selection and the role of less-invasive decompressive measures, like subcutaneous linea alba fasciotomy or component separation techniques, is lacking in the 2013 consensus management guidelines by the Abdominal Compartment Society on IAH and ACS.

4??Large prospective trials are needed to identify triggers and effective and safe surgical decompression methods in SAP patients with ACS.