Asian Journal of Research in Surgery

The open abdomen has become an established strategy in the management of severe intra-abdominal catastrophe, whether arising from trauma, abdominal sepsis, vascular emergencies, or abdominal compartment syndrome. Over the past two decades, the technique has moved from a salvage manoeuvre associated with high mortality to a structured, protocol-driven pathway supported by dedicated closure systems, standardised classification, and multidisciplinary critical care. This review synthesises contemporary evidence on the indications, temporary abdominal closure methods, timing of definitive fascial closure, complication management, nutritional support, and long-term outcomes associated with open abdomen treatment. Particular attention is given to negative pressure wound therapy, mesh-mediated fascial traction, and adjunctive techniques such as botulinum toxin-assisted chemical component separation, all of which have altered the trajectory of primary fascial closure rates. The management of enteroatmospheric fistula, one of the most feared complications of prolonged open abdomen treatment, is discussed alongside strategies for nutritional optimisation in the catabolic, critically ill patient. Paediatric considerations and the long-term burden of incisional hernia and abdominal wall dysfunction are also examined. The review highlights persistent gaps in the evidence base, including the paucity of high-quality randomised data comparing closure techniques, inconsistent reporting of long-term functional outcomes, and limited representation of resource-constrained settings in existing studies. A structured approach to open abdomen management, grounded in early planning for definitive closure, judicious use of dynamic closure systems, and proactive nutritional and multidisciplinary support, offers the best prospect of reducing morbidity in this complex patient population.