Effect Of Nonelastic And Elastic Abdominal Binders On Intra-abdominal Pressure

Objective: Nonelastic and elastic abdominal binders are commonly used to protect incisions after laparotomy.But abdominal banding may reduce abdominal compliance(Cab),posing a potential risk to increase intra-abdominal pressure(IAP).This study is aim to investigate the effect of the two kinds of abdominal binders on the IAP,severity of disease and clinical outcomes in laparotomy patients at perioperative stage,in order to find out a certain type of abdominal binder with lower intra-abdominal hypertension(IAH)induced risk and more inclined to good treatment outcomes via objective data.Methods: Emergency / elective laparotomy patients(age?18years)who were admitted into the department of trauma surgery of Daping Hospital were randomly divided into nonelastic or elastic abdominal binder groups.Patients received routine operative procedure after measuring baseline intra-vesical pressure(IVP)with / without abdominal binders.Then a nonelastic / elastic abdominal binder was applied following the operation until 14 days after surgery or discharge.Demographic information was recorded at admition;SOFA(sequential organ failure assessment)and APACHE-?(acute physiology and chronic health evaluation-?)scores were recorded at preoperation,postoperative day one,the day when IVP measurement stopped,and the day before discharge;treatment outcomes such as initial postoperative flatus time,wound infection or dehiscence,time for removing stitches,et al.were record.Guidelines published by WSACS(world society of abdominal compartment syndrome,WSACS)in 2013 recommended IVP measurement as the “golden standard” for IAP monitoring.All patients,whether or not wearing abdominal binders,received standard IVP measurements according to the guidelines through preoperation to postoperative day 7(IVP monitoring should be stopped if death,discharge,transfer,catheter removal,whichever came first).Results: Fifty-seven patients admitted from May 15,2014 to Oct.11,2014,enrolled,including 28 in the nonelastic abdominal binder group(49.12%)and 29 in the elastic binder group(50.88%).There was no significantly statistical difference in the demographic information between the two groups.Despite of wearing an abdominal binder or not,IAP roughly demonstrated a downward trend from postoperative day 1 to day 7(p=0.000).No significantly statistical difference of IAP(p=0.147)was observed between the 2 groups from preoperation to postoperative day 7 when people did not wear an abdominal binder.Both kinds of abdominal binders could elevate IAP significantly,the mean increments were 2.86±1.08mmHg(nonelastic binder)and 1.09±0.67 mm Hg(elastic binder),respectively.The nonelastic one was more capable than the elastic one(p=0.001).There was no difference in the SOFA and APACHE-?scores between the two groups during the measurement period(p values were 0.129,0.768,respectively).The SOFA score increased and then gradually decreased after the operation(p = 0.045),and peaked(1.19 ± 2.27 points)on the first postoperative day.The APACHE-score showed a trend similar ?to the SOFA score(p = 0.051),and also peaked(6.26 ± 4.79 points)on postoperative day one.During the survey,no incision dehiscence was reported,incision infections occured in 3 cases(5.26%),but no intergroup difference was showed(nonelastic abdominal binder group vs.elastic binder group: 1 vs.2,p=1.000).There was no significantly statistical difference in the treatment outcomes between the two groups,except for the initial time of out-of-bed activity was earlier in the elastic binder group than in the nonelastic group(3.15 ± 1.96 d vs.5.00 ± 3.66 d,p = 0.028).Conclusion: Both noneelastic and elastic abdominal binders can increase patients' IAP,the increment elevated by the former one is much more significantly,the latter is more favorable to promote postoperative recovery.Given that the two types of binders can inhibit the Cab,therefore,IAH risk may increased.During the binding of any kinds of binders,enhanced IAP and organ function monitoring is proper to avoid adverse effects of the binders.Patients with IAH should avoid using abdominal binders,if necessary,elastic binders are recommended.