Modified Management of Abdominal Compartment Syndrome Using the Arrowhead Regional Medical Center Plication Method (ARMC PM): A Bedside Plication Approach Based on the Bogota Bag.

Abstract

Background Several devices are marketed to help with abdominal closure. We aim to describe a novel approach to the management of abdominal compartment syndrome (ACS) using relatively inexpensive and available materials. Methods Fifty-two trauma patients were identified with abdomens left open for staged laparotomy. We utilized a method for treatment of ACS that involved suturing a folded transparent drape to the fascial edge using a continuous non-absorbable suture along with a moistened gauze roll that is placed along the edges of the fascia next to a suction drain, creating a vacuum wound dressing covered by Ioban^TM (3M Health Care, St. Paul, MN, USA). At the bedside, the outer layer of the drape is plicated with a heavy running suture to tighten the bag and approximate the fascia. The Arrowhead Regional Medical Center Plication Method (ARMC PM) is named after the hospital where it was developed. Results Complete fascial and skin closure was achieved in 100% of patients treated for ACS with the ARMC PM technique (p=0.026). Among these patients, the median duration of Bogota bag placement prior to definitive closure was three days. When comparing this cohort to a historical control group in which definitive closure was not achieved, there was a statistically significant reduction in mortality (17% vs. 71%; p=0.048). Notably, no cases of bowel evisceration or enteric fistula occurred with this method. Conclusion The ARMC PM is technically simple, allowing for the successful approximation of fascia at the bedside without the need for general anesthesia, thereby minimizing the transport of critically ill patients to the operating table. This technique is an effective and inexpensive method in the management of open abdomens.