# A Case of Abdominal Closure Using Endoscopic Anterior Component Separation Following Open Abdomen Management for Colon Perforation

## TL;DR

A patient with a colon perforation was successfully treated with endoscopic anterior component separation after open abdomen management, avoiding complications and achieving long-term recovery.

## Contribution

This is the first reported case of endoscopic anterior component separation used for definitive closure after open abdomen management.

## Key findings

- Endoscopic anterior component separation was successfully used to close the abdomen after colon perforation without surgical site occurrences.
- The patient remained complication-free for 17 months post-surgery with intact abdominal wall integrity.
- The technique offers potential for minimally invasive care and reduced complications in open abdomen management.

## Abstract

In open abdomen management (OAM), consistent early closure is crucial to avoid complications and improve short- and long-term outcomes. Open anterior component separation (OCS) has been reported to be a method for early definitive closure after OAM.

Originally, OCS is a common treatment option for incisional hernias. However, a major drawback is the high incidence of surgical site occurrences (SSOs) owing to impaired blood flow. This is caused by damage to the perforating branches supplying the skin from the rectus abdominis muscle, necessitating extensive subcutaneous dissection. To overcome these limitations, endoscopic anterior component separation (ECS) was developed. By eliminating the need for extensive subcutaneous dissection, perforating branches were preserved in the abdominal wall, significantly reducing SSOs.

While reports of OCS being performed for definitive closure after OAM are occasionally seen, there have been no previous case reports applying ECS. We therefore present this case.

A man in his 50s was followed up for multiple visceral artery aneurysms. Surgery was performed for hepatic and splenic artery aneurysms. The patient developed a postoperative pancreatic fistula that progressed favorably. However, on POD 22, the patient developed colonic perforation, necessitating emergency surgery. Owing to significant intestinal edema associated with inflammation and adhesion lysis, closure was difficult, leading to OAM. A second examination was performed 2 days later, but closure remained difficult. The abdomen was closed using ECS. There were no SSOs. After treatment for an intra-abdominal abscess, the patient was discharged 40 days after initial surgery for colon perforation. Seventeen months postoperatively, the patient remained complication-free with well-maintained abdominal wall integrity.

OCS, which enables mesh-free closure after trauma or infection surgery, is highly useful. ECS can also be applied for early definitive closure after OAM, offering potential for minimally invasive care and reduced SSO. While no previous reports exist on applying ECS after OAM, its relatively simple technique warrants wider adoption, the further accumulation of data, and an evaluation of cases.