Question

A 73 year old man undergoes a laparotomy for mesenteric infarction. An extensive small bowel resection is undertaken. A planned re-look laparotomy is scheduled to occur in 24 hours time. What is the most appropriate closure strategy in this situation?

Answer 1

The most appropriate strategy for closing a resected bowel in an elderly patient with a planned re-look laparotomy is to use a temporary abdominal closure technique. This allows for easy re-access, management of complications, and additional necessary interventions.

Step-by-step explanation:

The most appropriate closure strategy for a 73-year-old man undergoing a laparotomy for mesenteric infarction followed by an extensive small bowel resection with a planned re-look laparotomy in 24 hours is likely to involve a temporary abdominal closure technique. Given the context, the use of techniques like damage control surgery with a temporary closure facilitates re-assessment and additional procedures. Since further intervention is anticipated, definitive closure is generally avoided at this stage to allow for access, manage potential complications such as swelling, and ensure the possibility of further resections if needed.

Options such as a vacuum-assisted closure device or other temporary closure materials may be used to protect the abdominal contents and prevent contamination. The goal is to achieve a balance between maintaining abdominal domain and preparing for the subsequent operations.