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2008, Número 2

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Cir Cir 2008; 76 (2)


Abdomen abierto. Evolución en su manejo

Tavares-de la Paz LA, Andrade-de la Garza P, Goné-Fernández A, Sánchez-Fernández P

Idioma: Español
Referencias bibliográficas: 60
Paginas: 177-186
Archivo PDF: 140.84 Kb.


RESUMEN

La utilización de la estrategia quirúrgica del abdomen abierto ha ido en aumento al tiempo que la comunidad quirúrgica se familiariza con sus mecanismos de acción, sus ventajas y desventajas. Sin embargo, se asocia con morbilidad y mortalidad elevadas, y las diversas técnicas para proteger el contenido intraabdominal no pueden ser utilizadas de forma estandarizada en los distintos escenarios clínicos. El objetivo de este trabajo es revisar los orígenes, indicaciones actuales y las controversias del abdomen abierto, así como las técnicas más empleadas para el cierre temporal de la pared abdominal. Se realizó una búsqueda en las base de datos Medline y Ovid, para identificar artículos relacionados con abdomen abierto, cierre temporal de la pared abdominal y reparación abdominal en etapas. Se encontró que la técnica está justificada en pacientes traumatológicos, con síndrome compartamental abdominal o con sepsis intraabdominal severa. El cierre temporal de la pared abdominal deberá siempre individualizarse para cada escenario clínico; la técnica más estudiada y que parece ofrecer los mejores resultados es la del vacuum pack. En nuestra experiencia, no recomendamos el uso de malla protésica como regla general. La estrategia del abdomen abierto es útil en situaciones quirúrgicas complejas y en pacientes en estado crítico. Su uso deberá siempre evaluarse minuciosamente e individualizarse, conociendo las complicaciones que puede desarrollar el paciente al ser sometido a la misma.


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