CONTINUOUS FASCIAL TRACTION SYSTEM*: PREVENTING FASCIA RETRACTION OF AN OPEN ABDOMEN

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Abstract We report a 45-year-old male patient on whom a laparoscopic gastric bypass was performed without intraoperative complications. On day one post-surgery (PS), the patient showed mild abdominal distension and poor pain control. On day two of PS, the patient presented with acute abdominal distension requiring an urgent surgical revision. The findings of this surgery were small bowel ischemia with neither leakage from anastomosis, nor visible perforations. The patient was transported for a CT scan with an open abdomen showing permeable vessels. The intervention the following day found areas with poor blood flow; a 2 mm leakage on the gastro-jejunal anastomosis was repaired with 3 simple stitches. Because an abdomen primary closure approach wasn’t possible, a continuous fascial traction system* was used. Twelve traction points were placed on the anterior rectus sheath. The traction system allowed for the maintenance of an open abdomen for subsequent revision surgeries without reopening the abdomen wall and also for the prevention of fascial retraction. For control of the open abdomen, the patient was admitted to ICU, and up to four additional revision surgeries were performed resulting in increased blood flow of the small bowel. On day fourteenth PS, the abdomen was successfully primarily closed without the need for component separation techniques. After a 64-day hospital stay, the patient was discharged. At year one follow up, the patient had fully recovered with a 50 kg weight loss and a completely competent abdominal. *Fasciotens abdomen®

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