Planned Open Abdomen
or
STAR

Staged Abdominal Repair

Synomyms: Etappenlavage or Damage Control and Repair ( DC&R )

STAR is a radical but easy operative approach to he difficult abdomen: Staged abdominal repair is a conceptual operative approach that combines the advantages of planned relaparotomy and open management with a minimal rate of complications. Its definition is listed below.

DEFINITION of Staged Abdominal Repair (STAR)

(STAR) is one Operation of serial abdominal entries, planned either before or during the first INDEX STAR, and performed every 24 to 36 hours

with

Temporary closure of the abdomen,

with controlled tension exerted to the fascia,

but avoiding increase in intra-abdominal pressure

thus avoiding harm on pulmonary, renal, CV, and hepatic function and

temporary abdomianl closure bridging the fascial gap with the fascia prosthesis

and final fascia-to-fascia closure of the abdomen

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Algorythm for planned open abdomen

The Figure above depicts the STAR algorithm.When a severe abdominal problem is encountered and STAR is indicated, the first of a series of abdominal entries is initiated the necessary source control and purging performed and the first or INDEX STAR is completed by temporarily closing  with the artificial bur.  When the abdomen is reopened the next day STAR is continued, if the problem persists or if there is still too much edema. If new pathology is encountered STAR is also continued and planned abdominal entries are performed until the pathology is healing, edema has resolved and the abdominal cavity can be closed without major tension. Definitive closure is part if the STAR concept and comprises fascial closure and even skin closure if there is sufficient granulation tissue in the abdominal wound which usually is the case after six abdominal entries.
Using the indications presented in Table 1, about 10-15 percent of all patients operated upon IAI will qualify for this management policy.  A prospective, but not randomized, attempt to compare "closed" and "open" abdomen techniques did not demonstrate an advantage of the latter.  On the other hand, another prospective study showed the STAR approach to be superior to conventional operative therapy when patients at equal mortality risk were compared  (Figure 17)