Resumen

SANCHEZ ARIAS, Mario. Abdomen abierto. Acta méd. costarric [online]. 2000, vol.42, n.2, pp.76-80. ISSN 0001-6002.

The management of patients with severe injuries in the abdomen in which the surgeon is not able to resolve the problem at the fírst time have changed remarkably. At present many surgeons are using the 'open abdomen' in these cases. This article reports our experience with the patients that we have been treated with open abdomen in the Surgical Intensive Care Unit at Calderón Guardia Hospital. A total of 149 patients were treated between 92-98. However, we studied only 73 cases which had the required information complete. These patients ranged from 20 to 83 years of age, with a median of 48. A 65% were males and the APACHE score was 12.2 at the time of the laparostomy. The most frecuent diagnosis was intrabdominal sepsis and leaks. All of them were managed either with mesh or plastic bag. The global mortality was 35%. The number of operations averaged 4.2. Tbe patients had a mean stay of 42 days, 24 days in the intensiva care unit and 20 days with the open abdomen. Additionally the patients who were treated by one surgeon had 12.5% mortality and those treated by more than one surgeon had 34% mortality. We conclude that this method is better for this kind of patients, who otherwise will have mortality close to 100%. We can also point out that in this kind of management it is very important to have nutritional support, mechanical ventilation. The surgeon has to do a therapeutic plan at the first operation and commit lo the case for the future interventions.

Palabras clave : Abdomen abierto; laparostomía; relaparotomia planeada.