Introduction
The concept of leaving the abdomen open to manage intra-abdominal pressure and allow for repeated interventions has transformed surgical outcomes. Open abdomen techniques are often employed in emergency and complex surgical situations where the surgical site cannot be closed immediately due to severe trauma, contamination, swelling, or other complications. In the United States, it is estimated that there are more than 2 million open abdomen surgery cases per year; however, the management of open abdomens poses significant challenges, with existing literature consistently reporting morbidity rates of 30-50%.
In recent years, the management of open abdomen cases has seen significant advancements and development to enhance patient outcomes. The AbClo device represents an outstanding advancement that aims to revolutionize the non-invasive management of open abdominal wounds with a 98% primary fascial closure rate.
In this series, we will explore the significance open abdomens provide as a surgical care option and the relevant issues faced, including the lack of standardized care options that offer high success rates for fascial traction.
We will take a comprehensive look at the innovation of AbClo device and cover its concept, clinical applications, benefits, published supporting studies, cost-cutting effects, and much more..
(Blog 1 of 3)
The “WHY” of AbClo
Open Abdomens: A Surgical Care Option.. What is Open Abdomen?
The open abdomen (OA)1 is defined as an intentional decision to leave the fascial edges of the abdomen unapproximated. The abdominal contents are potentially exposed and therefore must be protected with a temporary coverage, which is referred to as temporal abdominal closure (TAC). This technique is typically indicated in cases where primary closure of the abdominal wall poses significant risks due to excessive swelling or bleeding. OA is also considered in acute conditions when primary fascial closure is not possible or likely to fail, such as in severe abdominal trauma, pancreatitis, bowel ischemia, or hollow organ perforation.
Other conditions, such as loss of domain, chronically infected mesh, or connective tissue disorders, may also benefit from a period of OA when there are concerns about anastomotic integrity or when a gradual tensioning of the abdominal wall is required for large defects, to avoid abdominal compartment syndrome.
The Challenges of Open Abdomen Management
Open abdomen management is not without its challenges. In the United States, research shows that almost 1 in 5 open abdomen procedures are left intentionally open for further treatment, and 38% of these “fail to close” 2. The complications include entero-atmospheric fistula, infection, and large ventral hernias that require complicated repair with subsequent additional visits to the operating room (OR) for sequential closure and thus longer hospital stays.
Key Aspects of Open Abdomen Management
The optimal management of the OA must focus on TAC, while preventing lateral retraction of the abdominal wall musculature and aiming for early primary fascial closure. 3
Traditional methods, such as using sterile gauze, negative pressure wound therapy, or conventional plastic wraps, have been used for temporary closures; however, they come with many limitations related to infection control and patient comfort. The use of negative pressure wound therapy (NPWT) or vacuum-assisted closure (VAC) systems has dominated the field. While these techniques are useful in the management of abdominal fluids and secretions, they provide minimal support to prevent lateral retraction of the abdominal wall fascial edges and rectus muscles.
Other OA management strategies include the application of devices that are surgically stitched through the abdominal wall to provide mechanical support and prevent the lateral retraction of fascial edges. However, these devices may cause further damage to the healing abdomen. Additionally, these devices are costly and resource-intensive to the health care system due to the necessity of frequent trips to the operating room for application and readjustments.
These challenges emphasized the need for devices that offer more than just temporary solutions—they must facilitate healing while minimizing risks.
The Rise of the AbClo Device: A Game Changer..
The AbClo (Abdominal Fascia Closure Device) by InventoRR MD Inc. is a trademarked product manufactured in Canada and approved for sale in Canada and the USA.
The AbClo system stands out as an innovative and intuitive non-invasive temporary abdominal fascia closure device. Designed with patient safety and surgical efficacy in mind, AbClo offers a safer and more efficient approach that simplifies complex surgical scenarios.
The AbClo device facilitates controlled closure of the abdomen while enabling continued access for monitoring and further intervention if necessary.
Its unique design promotes optimal conditions for healing with 98% primary fascial closure. 4
The Concept of AbClo.. Why is AbClo unique?
AbClo is the only commercially available non-invasive approach supporting the closure of intentionally left-open abdomens.
The AbClo Abdominal Fascia Closure Device is an external, non-invasive abdominal closure system intended to stabilize and/or facilitate gradual fascial closure of midline abdominal defects.
Being external and non-invasive, AbClo offers the benefits of closing an incision and protecting fascial integrity at the patient’s bedside. AbClo can be applied, sequentially tightened, and monitored in the ICU, thus reducing surgical strain and time in the operating room (OR).
Usually, AbClo is tightened daily by a surgeon or physician at the bedside, while the nursing team monitors the pressure and position of the device. This allows freeing up surgeons for other procedures instead of handling re-adjustments and challenges of invasive fascial traction devices in the OR. It also helps surgical teams focus more on patient care and achieving greater surgical efficiency.
AbClo works like a corset, supporting and stabilizing the abdominal wall. The application of the AbClo System prevents lateralization of the fascial margin by engaging the abdominal wall muscles and applying a gentle, unrelenting dynamic appositional force. It is beneficial for managing intra-abdominal pressure, preventing seroma formation, and reducing the risk of infection, fistulas, and hernias by preventing fascial retraction. AbClo gradually reapproximates the fascial edges, preventing damage to the skin and abdominal wall fascia, reducing the fascial gap, and promoting primary fascial closure.
The non-invasive nature of AbClo technology not only reduces the likelihood of complications but also means that patients experience less pain, faster healing, reduced scarring, and a smoother recovery process, all of which contribute to shorter hospital stays and a better patients’ overall surgical experience.
In the next part of this series, we will explore the “How” of AbClo, going deeper into how AbClo works, its clinical outcomes, and how these benefits further advance the field of open abdomen care.
REFERENCES
- Coccolini F, Montori G, Ceresoli M, Catena F, Moore EE, Ivatury R, Biffl W, Peitzman A, Coimbra R, Rizoli S, Kluger Y, Abu-Zidan FM, Sartelli M, De Moya M, Velmahos G, Fraga GP, Pereira BM, Leppaniemi A, Boermeester MA, Kirkpatrick AW, Maier R, Bala M, Sakakushev B, Khokha V, Malbrain M, Agnoletti V, Martin-Loeches I, Sugrue M, Di Saverio S, Griffiths E, Soreide K, Mazuski JE, May AK, Montravers P, Melotti RM, Pisano M, Salvetti F, Marchesi G, Valetti TM, Scalea T, Chiara O, Kashuk JL, Ansaloni L. The role of open abdomen in non-trauma patient: WSES Consensus Paper. World J Emerg Surg. 2017 Aug 14;12:39. doi: 10.1186/s13017-017-0146-1. PMID: 28814969; PMCID: PMC5557069. PubMed (2017) The role of open abdomen in non-trauma patient: WSES Consensus Paper. https://pubmed.ncbi.nlm.nih.gov/28814969/
- BusinessWire (2025). Revolutionary Surgery Closure Device Evaluated at Alberta Health Services. https://www.businesswire.com/news/home/20230206005162/en/Revolutionary-Surgery-Closure-Device-Evaluated-at-Alberta-Health-Services
- Mahoney, Eric J. MD, FACS; Bugaev, Nikolay MD; Appelbaum, Rachel MD; Goldenberg-Sandau, Anna DO; Baltazar, Gerard A. DO, FACOS, FACS; Posluszny, Joseph MD; Dultz, Linda MD, MPH; Kartiko, Susan MD, PhD, FACS; Kasotakis, George MD, MPH, FACS, FCCM; Como, John MD; Klein, Eric MD, FACS. Management of the open abdomen: A systematic review with meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma (2022). https://www.east.org/education-resources/practice-management-guidelines/details/management-of-the-open-abdomen-a-systematic-review-with-metaanalysis-and-practice-management-guideline-from-the-eastern-association-for-the-surgery-of-trauma
- Asad Naveed, Niels D Martin, Mohammed Bawazeer, Atif Jastaniah, Joao B Rezende-Neto. Early placement of a non-invasive, pressure-regulated, fascial reapproximation device improves reduction of the fascial gap in open abdomens: a retrospective cohort study (2024). https://abclomedical.com/wp-content/uploads/2024/10/AbClo-Early-vs-Late.pdf