Hospital Administration

Thank you for visiting openabdomen.org, a resource for surgeons treating patients with abdominal compartment syndrome and/or a difficult to treat surgical abdomen.

Hospitals that perform the STAR procedure can offer their high risk patients one more technique to:

• decrease length of stay and avoidance of re-admissions,
• unnecessary colostomies,
• long term morbidity such as giant abdominal wall hernias with and without fistulas and
• increased quality of life.

openabdomen.org describes a procedure call Staged Abdominal Repair or STAR. This procedure employs multiple entries into the abdomen facilitated by a Velcro® derived temporary abdominal wall closure device. The patients usually remain intubated in the intensive care unit and are taken daily to the operating room to monitor the healing process and to pro-actively identify and address potential complications. Patients who benefit from the STAR procedure have complex conditions with mortality rates of over 30-40% if untreated. The STAR procedure enables the surgeon to limit the length of each individual abdominal entry in these fragile patients, allows patients time to improve between entries and gives the surgeon the ability to temporarily delay more invasive interventions until the patient can tolerate them. STAR furthermore allows the surgeon to evaluate previous interventions, if necessary revise them, and identify new problems before they become serious/more complicated and difficult to manage.

The most successful temporary fascial closure device is the artificial bur. Patient's with abdominal compartment syndrome (high intra-abdominal pressure) often require pressure release until the intra-abdominal problems are resolved. The artificial bur allows both the repeated abdominal entry without injuring the abdominal fascial edges while simultaneously allowing judicious adjustment of intra-abdominal pressure. As the pressure decreases, the surgeon increasingly overlaps the bur's edges until the abdominal fascia can be closed. Thus long term hernias can be avoided and the patient has a better cosmetic outcome and quality of life. The artificial bur is used in conjunction with a hypobaric (vacuum) wound dressing which allows sterile containment of the artificial bur as well as clean removal of intra-abdominal fluids. As opposed to other similar devices the hospital's wall suction suffices for wound dressing maintenance and thus a vacuum pump does not have to be rented or purchased.

Peer reviewed literature shows many references to improved patient survival and less long term morbidity. While the STAR procedure requires significant dedication by the surgeon and hospital staff, the outcome justifies this effort. Centers that employ the STAR procedure become locally and regionally known for the superior care where other options are often futile. This reputation leads to increased referrals of these types of patients, and may change local and regional referral patterns.

Please feel free to browse through our surgeon's resource website. You can find peer reviewed publications and actual case descriptions along with online discussions.

Should you have any questions please feel free to contact us at support@openabdomen.org.