Nasa P, Chanchalani G, Juneja D, Malbrain ML. Surgical decompression for the management of abdominal compartment syndrome with severe acute pancreatitis: A narrative review. World J Gastrointest Surg 2023; 15(9): 1879-1891 [PMID: 37901738 DOI: 10.4240/wjgs.v15.i9.1879]
Corresponding Author of This Article
Prashant Nasa, MD, Chief Physician, Department of Critical Care Medicine, NMC Specialty Hospital, Al Nahda 2, Amman Street, Dubai 7832, United Arab Emirates. dr.prashantnasa@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Sep 27, 2023; 15(9): 1879-1891 Published online Sep 27, 2023. doi: 10.4240/wjgs.v15.i9.1879
Surgical decompression for the management of abdominal compartment syndrome with severe acute pancreatitis: A narrative review
Prashant Nasa, Gunjan Chanchalani, Deven Juneja, Manu LNG Malbrain
Prashant Nasa, Department of Critical Care Medicine, NMC Specialty Hospital, Dubai 7832, United Arab Emirates
Prashant Nasa, Department of Internal Medicine, College of Medicine and Health Sciences, Al Ain 15551, United Arab Emirates
Gunjan Chanchalani, Department of Critical Care Medicine, K.J. Somaiya Hospital and Research Centre, Mumbai 400022, India
Deven Juneja, Institute of Critical Care Medicine, Max Super Specialty Hospital, New Delhi 110017, India
Manu LNG Malbrain, First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin 20-954, Poland
Manu LNG Malbrain, Executive Administration, International Fluid Academy, Lovenjoel 3360, Belgium
Manu LNG Malbrain, Medical Data Management, Medaman, Geel 2440, Belgium
Author contributions: Nasa P conceptualized and designed the article; Nasa P and Chanchalani G performed acquisition of data, analysis and interpretation of data, and drafted the article; Juneja D and Malbrain ML revised the article; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: Nasa P declared to be on the advisory board of Edwards life sciences. Malbrain ML is Professor of Critical Care Research at the 1st Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Poland. He is co-founder, past-President and current Treasurer of WSACS (The Abdominal Compartment Society, http://www.wsacs.org). He is member of the medical advisory Board of Pulsion Medical Systems (now fully part of Getinge group), Serenno Medical, Potrero Medical, Sentinel Medical and Baxter. He consults for B. Braun, Becton Dickinson, ConvaTec, Spiegelberg, Medtronic, MedCaptain, and Holtech Medical, and received speaker’s fees from PeerVoice. He holds stock options for Serenno and Potrero. He is co-founder and President of the International Fluid Academy (IFA). The IFA (http://www.fluidacademy.org) is integrated within the not-for-profit charitable organization iMERiT, International Medical Education and Research Initiative, under Belgian law. Other authors do not declare any conflict of interest in relation to the content of the present paper.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Prashant Nasa, MD, Chief Physician, Department of Critical Care Medicine, NMC Specialty Hospital, Al Nahda 2, Amman Street, Dubai 7832, United Arab Emirates. dr.prashantnasa@gmail.com
Received: May 23, 2023 Peer-review started: May 23, 2023 First decision: July 8, 2023 Revised: July 20, 2023 Accepted: August 1, 2023 Article in press: August 1, 2023 Published online: September 27, 2023
Abstract
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. There was no randomized controlled trial published on the topic. 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). The morbidity and complications of an open abdomen after decompressive laparotomy should be weighed against the inadequately treated but, potentially lethal ACS. 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. This narrative review focuses on the current evidence regarding surgical decompression techniques for managing ACS in patients with SAP. However, there is a lack of high-quality evidence on patient selection, timing, and modality of surgical decompression. Large prospective trials are needed to identify triggers and effective and safe surgical decompression methods in SAP patients with ACS.
Core Tip: Intra-abdominal hypertension (IAH) plays a pivotal role in the pathophysiology of new-onset organ failure in patients with severe acute pancreatitis (SAP). Abdominal compartment syndrome (ACS), a sustained elevation of Intra-abdominal pressure of more than 20 mmHg associated with one or more new organ dysfunction, reflects an unabated progression of IAH. Surgical decompression is an effective core strategic component to manage an overt ACS. However, the morbidity of an open abdomen after decompressive laparotomy should be weighed against the potentially lethal and inadequately treated ACS. Prospective randomized studies are required to evaluate the appropriate timing, technique, and triggers for surgical decompression in ACS associated with SAP.
