Stepwise plication of abdominal mesh technique for open abdomen closure.

Abstract

Purpose: To present the stepwise plication of abdominal mesh (SPAM) as a standardized dynamic closure technique that combines mesh-mediated fascial traction with negative pressure wound therapy for gradual abdominal wall approximation.

Methods: In this technical report, we present SPAM for progressive closure of peritoneostomy with excessive abdominal wall retraction. It involves a central mesh incision followed by progressive tightening via hemostatic clamp rotation (similar to opening a can with a key), without full-thickness mesh cut. The mesh is secured with continuous suture and covered with a non-commercial negative pressure system. Cycles are repeated every 48-72 hours until fascial closure.

Results: SPAM was applied in four patients: three successful cases (52-year-old male with rectal perforation, 36-year-old female post-Hartmann evisceration, 63-year-old female with gastrojejunal anastomosis leak) achieved primary fascial closure in a median of 10 days, with well-tolerated traction, no enteroatmospheric fistula, or incisional hernia. In one failure (59-year-old male with gastrojejunal leak post-laparoscopic gastrectomy), bleeding occurred during traction (controlled surgically), yet the technique was discontinued due to progressive clinical deterioration.

Conclusion: SPAM offers a practical, standardized, reproducible approach to delayed fascial closure, particularly in resource-limited settings, enabling controlled progressive approximation without mesh resection.