Effect of decompressive laparotomy on organ function in patients with abdominal compartment syndrome: a systematic review and meta-analysis

Van Damme, Lana; De Waele, Jan J.

doi:10.1186/s13054-018-2103-0

Cited by 74Abdominal Surgery and ComplicationsSepsis Diagnosis and TreatmentRespiratory Support and Mechanisms

Effect of decompressive laparotomy on organ function in patients with abdominal compartment syndrome: a systematic review and meta-analysis

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Van Damme, Lana, De Waele, Jan J.·2018·Critical Care

DOI 10.1186/s13054-018-2103-0PMC PMC6060511

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Abstract

Decompressive laparotomy has been advised as potential treatment for abdominal compartment syndrome (ACS) when medical management fails; yet, the effect on parameters of organ function differs markedly in the published literature. In this study, we sought to investigate the effect of decompressive laparotomy on intra-abdominal pressure and organ function in critically ill adult and pediatric patients with ACS, specifically focusing on hemodynamic, respiratory, and kidney function and outcome. A systematic review and meta-analysis of the literature was performed. Articles reporting data on intra-abdominal pressure (IAP), hemodynamic (mean arterial pressures [MAP], central venous pressure [CVP], cardiac index [CI], heart rate [HR], systemic vascular resistance index [SVRI] and/or pulmonary capillary wedge pressure [PCWP]), respiratory (positive end-expiratory pressure [PEEP], peak inspiratory pressure [PIP] and/or ratio of partial pressure arterial oxygen and fraction of inspired oxygen [P/F ratio]), and/or urinary output (UO) following decompressive laparotomy were analyzed. A total of 15 articles were included; 3 included children only (aged 18 years or younger). Of the 286 patients who were included, 49.7% had primary ACS. The baseline mean IAP in adults decreased with an average of 18.2 ± 6.5 mmHg following decompression, from 31.7 ± 6.4 mmHg to 13.5 ± 3.0 mmHg. There was a decrease in HR (12.2 ± 9.5 beats/min; p = 0.04), CVP (4.6 ± 2.3 mmHg; p = 0.022), PCWP (5.8 ± 2.3 mmHg; p = 0.029), and PIP (10.1 ± 3.9 cmH 2 O; p < 0.001) and a mean increase in P/F ratio (70.4 ± 49.4; p < 0.001) and UO (95.3 ± 105.3 ml/h; p < 0.001). In children, there was a significant increase in MAP (20.0 ± 2.3 mmHg; p = 0.006), P/F ratio (238.2; p < 0.001), and UO (2.88 ± 0.64 ml/kg/h; p < 0.001) and a decrease in CVP (7 mmHg; p = 0.016) and PIP (9.9 cmH 2 O; p = 0.002). The overall mortality rate was 49.7% in adults and 60.8% in children following decompressive laparotomy. Decompressive laparotomy resulted in a significantly lower IAP and had beneficial effects on hemodynamic, respiratory, and renal parameters. Mortality after decompressive laparotomy remains high in both adults and children.

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The authors found a weak correlation between delay in surgery and death and thus suggest prompt operation.
“The authors found a weak correlation between delay in surgery and death and thus suggest prompt operation.”
From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [198]
The Discussion reports a weak correlation between the timing of decompressive laparotomy and mortality. It also says the correlation had limited clinical relevance and that the optimal timing is unknown; it recommends considering surgery when medical options fail, not prompt operation on the basis of that correlation. The Results report a nonsignificant correlation across all adult patients. (LLM, conf=0.90)
Experimental — accuracy not yet measured
Death after decompression laparotomy was still as high as 49.7%.
“However, death after decompression laparotomy was still as high as 49.7%.”
From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [198]
In patients with ACS, decompression laparotomy has been shown to effectively reduce IAP and to improve oxygenation and urinary output.
“In patients with ACS, decompression laparotomy has been shown to effectively reduce IAP and to improve oxygenation and urinary output. 198”
From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [198]

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Additional file 1: of Effect of decompressive laparotomy on organ function in patients with abdominal compartment syndrome: a systematic review and meta-analysis
Damme, L. V., & Waele, J. J. D. (2018) · Figshare · doi:10.6084/m9.figshare.6864227
Additional file 2: of Effect of decompressive laparotomy on organ function in patients with abdominal compartment syndrome: a systematic review and meta-analysis
Damme, L. V., & Waele, J. J. D. (2018) · Figshare · doi:10.6084/m9.figshare.6864224
Decompressive laparotomy for abdominal compartment syndrome – a critical analysis
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Decompressive laparotomy for abdominal compartment syndrome
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ABDOMINAL DECOMPRESSION FOR ABDOMINAL COMPARTMENT SYNDROME IN CRITICALLY ILL PATIENTS: A RETROSPECTIVE STUDY
Waele, J. J. D., Desender, L. M., laet, I. D., Ceelen, W. P., Pattyn, P., & Hoste, E. A. J. (2010) · Acta Clinica Belgica · doi:10.1179/acb.2010.65.6.005 · Cited by 31 · see citing works

Authors: Van Damme, L., & De Waele, J. J.
ORCID: De Waele, Jan J.
Venue: Critical Care
Publisher: Springer Science and Business Media LLC
Published: 2018-07-25
Volume: 22
Issue: 1
Pages: 179-179
ISSN: 1364-8535 (ISSN-L)
DOI: 10.1186/s13054-018-2103-0
PMC: PMC6060511
OpenAlex: W2883747315
Cited by: 74
References: 35
Citations by year: 2026: 5 · 2025: 9 · 2024: 8 · 2023: 7 · 2022: 10 · 2021: 17 · 2020: 9 · 2019: 9
FWCI: 1.56
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (tdm)
Locations: Critical Care (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, other-oa)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Ghent University Academic Bibliography (Ghent University) (submittedVersion, cc-by)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
Keywords: decompressive laparotomy, abdominal compartment syndrome, intra-abdominal pressure, organ function, hemodynamics, respiratory function, renal function, urine output, pediatric patients, critical illness, positive end-expiratory pressure, oxygenation, cardiac index, systemic vascular resistance index, central venous pressure, pulmonary capillary wedge pressure, mean arterial pressure, heart rate, peak inspiratory pressure
MeSH terms: Humans, Laparotomy, Lower Body Negative Pressure, Critical Illness, Decompression, Surgical, Intra-Abdominal Hypertension, Organ Dysfunction Scores

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Effect of decompressive laparotomy on organ function in patients with abdominal compartment syndrome: a systematic review and meta-analysis

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