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The effect of different types of abdominal binders on intra-abdominal pressure

DOI:10.15537/smj.2016.7.15217
Authors:
Hazim N Barnouti at Al-Mustansiriya University
Hazim N Barnouti
Lian-Yang Zhang
Lian-Yang Zhang
Lian-Yang Zhang
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Abstract

Objectives: To investigate the effect of non-elastic/elastic abdominal binders on intra-vesical pressure (IVP), physiological functions, and clinical outcomes in laparotomy patients at the perioperative stage. Methods: This prospective study was conducted from May to October 2014 at the Trauma Surgery Department, Daping Hospital, Chongqing, China. Laparotomy patients were randomly divided into non-elastic abdominal binder group (28 patients), and elastic abdominal binder group (29 patients). Binders were applied for 14 days following the operation, or until discharge. Demographic information, Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores (prior to the operation, on the first day after operation, the day IVP measurement was stopped, and one day before discharge), and outcomes were recorded. The IVP was measured before the operation to postoperative day 7. Results: There were no significant differences in the demographic information, outcomes, SOFA or APACHE-II scores between the 2 groups. Initial out-of-bed mobilization occurred earlier in the elastic binder group (3.2 ± 2.0 versus 5.0 ± 3.7 days, p =0.028). A greater increase in IVP was observed in the non-elastic binder group than in the elastic binder group (2.9 ± 1.1 versus 1.1 ± 0.7 mm Hg, p =0.000). Conclusion: Elastic binders have relatively little effect on IVP and are more helpful at promoting postoperative recovery than non-elastic binders. Therefore, elastic binders are more suitable for clinical use. Saudi Med J 2016; Vol. 37 (1): 66-72 doi: 10.15537/smj.2016.1.12865 How to cite this article: Zhang HY, Liu D, Tang H, Sun SJ, Ai SM, Yang WQ, et al. The effect of different types of abdominal binders on intra-abdominal pressure . Saudi Med J 2016; 37: 66-72 .
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815
www.smj.org.sa audi Med J 2016; Vol. 37 (7)
e effect of different types of abdominal
binders on intra-abdominal pressure
To the Editor
I have read with interest the article by Zhang et al.1
Scientifically, abdominal binders though frequently
used following laparotomy by many surgeons all over
the world, with French surgeons specifically being very
fond of them in the false belief that they protect the
laparotomy wound from wound dehiscence, incisional
hernia formation, seromas, and hematomas; there in no
past or current scientific evidence to support this belief.2
Regarding the effect of abdominal binders following
laparotomy on post-operative abdominal pain; the paper
of rothman et al,3 concluded that this is unclear and
is still largely uninvestigated. It is evident that the use
of abdominal binders following laparotomy is more a
matter of habit rather than scientific evidence.2 Scientific
evidence of their usefulness is limited. Looking into the
medical literature, only 4 trials on the use of abdominal
binders following laparotomy have been published,2
all with a small number of patients.ere are no data
supporting the false belief that the use of abdominal
binders following laparotomy prevent abdominal wall
complications.2 In addition to the lack of scientific
evidence of any significant benefit of abdominal
binders following laparotomy except for psychological
support; they carry many significant adverse effects
listed in the article of Zhang et al:1 1) limitation of
abdominal compliance, which may lead to increased
intra-abdominal pressure (IAP), thus increasing the
risk of intra-abdominal hypertension (IAH), and even
abdominal compartment syndrome.4 If this happens,
the condition of the patient will deteriorate, and the
prognosis will worsen. Such IAH will result in increased
intra-thoracic pressure, and even intra-cranial pressure,
and thus respiratory and nervous system dysfunction.
Also, increased IAP causing vascular compression
may end in renal ischaemia, and increased cardiac
preload further damaging physiological function;5 2)
oesophageal partial hiatus hernia, and short segment
acid reflux caused by increased IAP may contribute
to the occurrence of oesophago-gastric junction
adenoma in patients without acid reflux symptoms;6
3) a spontaneous non-traumatic trans-diaphragmatic
intercostal hernia.7 e long-term increase in IAP
due to long term use of an abdominal binder can
cause slimming and loosening of the diaphragm and
intercostal muscles weakening their resistance to the
rapidly increased pressure of the thoracic-abdominal
cavity.
With the lack of any proved benefit of abominal
binders following laparotomy except for psychological
support, and with the list of their possible adverse
effects listed in the paper by the authors, some of which
as increased IAP and its consequences may worsen
the prognosis and cause physiological dysfunction as
confessed by the authors; why use an abdominal binder?
who will use an abdominal binder?
Hazim N. Barnouti
Department of Surgery
Al-Mustansiriya Medical School
Baghdad, Iraq
Reply from the Author
We would like to thank Dr. Barnouti for his attention
and sincere enthusiasm for this article. Bouvier et al,2
mainly answered the question “Why do the surgeons
use abdominal binders?” is survey reflected surgeons’
clinical treatment habit and its derivation, but did not
focus on “whether it is reasonable?”. It is reported that
abdominal binders can alleviate postoperative pain and
anxiety, and can help to improve abilities of out-of-bed
mobilization. ese researches help to justify “the benefit
of abdominal binders”.8-10 Due to wide and long-term
use of abdominal binders in clinical treatment, scholars
pay inadequate attention on abdominal binders,
leading to the awkward situation, such as small sample
size of clinical study, and limited case-control study of
different types of abdominal binders, as well as leaving
many questions to be answered. e systemic review
by Rothman et al2 also did not absolutely certify “the
benefit of abdominal binders”,3 but also cannot be
falsified. Under this circumstance, the authors consider
that it is wise to prudently use and adjust strategy by
updating evidence. In this study,1 the authors pointed
out that current comparative studies of elastic and non-
elastic abdominal binders lacked objective evidence
regarding their advantages and disadvantages. erefore,
this study aims to clearly define the effects of different
abdominal binder types on IAP, physiology, and clinical
outcomes, and to find the binder type that has only a
small effect on IAP, minimizes the possibility of IAH,
assists in postoperative recovery, and provides guidance
for future clinical work. rough this study, we find that
elastic binders have relatively little effect on IAP and are
more helpful at promoting postoperative recovery than
non-elastic binders. erefore, we recommend using
Correspondence
OPEN ACCESS doi: 10.15537/smj.2016.7.15217
816 Saudi Med J 2016; Vol. 37 (7) www.smj.org.sa
elastic binders, which have relatively little effect on
IAP and abdominal compliance. At the same time, we
emphasize that while using abdominal binders, physical
function, and IAP should be closely monitored to avoid
iatrogenic injury. e use of abdominal binders should
be avoided in patients with IAH. If a binder must be
used, the application time should be minimal, and
it is essential not to wrap the abdominal binder too
tightly, and to closely monitor intra-vesical pressure and
avoid other factors that can affect IAP, intra-abdominal
volume, and abdominal compliance.
Every coin has 2 sides. e adverse effects of
abdominal binders on the body should also be noted.
is article listed some adverse events by abdominal
binders, but due to the different material, binding
method, binding duration, binding strength, and patient
types, its aim is mainly to show the bad consequences of
abdominal binders caused by neglect regulation.
We must admit that there are still many points need
to be revealed on abdominal binder use. We will reveal
the problems one by one in the following studies, and
continuously improve the research ideas and methods.
Lian-Yang Zhang
Trauma Center
State Key Laboratory of Trauma
Chongqing
China
References
1. Zhang HY, Liu D, Tang H, Sun SJ, Ai SM, Yang WQ, et al.
e effect of different types of abdominal binders on intra-
abdominal pressure. Saudi Med J 2016; 37: 66-72.
2. Bouvier A, Rat P, Drissi-Chbihi F, Bonnetain F, Lacaine F,
Marriete C, et al. Abdominal binders after laparotomy: review
of the literature and French survey of policies. Hernia 2014; 18:
501-506.
3. Rothman JP, Gunnarsson U, Bisgaard T. Abdominal binders
may reduce pain and improve physical function after major
abdominal surgery - a systematic review. Dan Med J 2014; 61:
A4941.
4. Malbrain ML, Roberts DJ, De Laet I, De Waele JJ, Sugrue M,
Schachtrupp A, et al. e role of abdominal compliance, the
neglected parameter in critically ill patients - a consensus review
of 16. Part 1: definitions and pathophysiology. Anaesthesiol
Intensive er 2014; 46: 392-405.
5. Cheatham ML. Intra-abdominal pressure: why are you not
measuring it? Crit Care Med 2014; 42: 467-469.
6. Lee YY, McColl KE. Disruption of the gastroesophageal
junction by central obesity and waist belt: role of raised intra-
abdominal pressure. Dis Esophagus 2015; 28: 318-325.
7. Lasithiotakis K, Venianaki M, Tsavalas N, Zacharioudakis G,
Petrakis I, Daskalogiannaki M, etal. Incarcerated spontaneous
transdiaphragmatic intercostal hernia. Int J Surg Case Rep
2011; 2: 212-214.
8 Cheifetz O, Lucy SD, Overend TJ, Crowe J. e effect
of abdominal support on functional outcomes in patients
following major abdominal surgery: a randomized controlled
trial. Physiother Can 2010; 62: 242-253.
9 Larson CM, Ratzer ER, Davis-Merritt D, Clark JR. e effect
of abdominal binders on postoperative pulmonary function.
Am Surg 2009; 75: 169-171.
10. Szender JB, Hall KL, Kost ER. A randomized-clinical trial
examining a neoprene abdominal binder in gynecologic surgery
patients. Clin Exp Obstet Gynecol 2014; 41: 525-529.
Effect of abdominal binder on IAP ... Barnouti
... The belts come in two sizes, either medium or large, and are designed as panels that come together in the front of the patient with a securing hook-and-loop fastener strap. 15 As an independent nursing intervention, the binder can have various uses for postoperative care as it provides compression and support to the upper and lower abdomen. 16 Abdominal binders are a complementary therapy for major abdominal surgery, 15 where they induce abdominal compression, which subsequently increases blood flow and reduces inflammation at the incision site facilitating rapid repair of tissues. ...
... 15 As an independent nursing intervention, the binder can have various uses for postoperative care as it provides compression and support to the upper and lower abdomen. 16 Abdominal binders are a complementary therapy for major abdominal surgery, 15 where they induce abdominal compression, which subsequently increases blood flow and reduces inflammation at the incision site facilitating rapid repair of tissues. 17 Based on the literature search, few studies have addressed the role of abdominal binders in women undergoing a cesarean delivery with no consensus regarding their benefits. ...
The effectiveness of the abdominal binder in relieving pain after cesarean delivery: A systematic review and meta‐analysis of randomized controlled trials
Article
  • Jan 2021
Background: Abdominal binder is a non-pharmacological method of relieving pain after surgical procedures. Objectives: To evaluate the effectiveness of the abdominal binder in relieving pain and distress scores after cesarean delivery (CD). Search strategy: The following terms were searched: cesarean section, cesarean, caesarean, abdominal deliveries, C-section, abdominal delivery, abdominal binding, binder, and abdominal binder. Selection criteria: Randomized controlled trials (RCTs) with patients undergoing CD receiving an abdominal binder compared with non-users of the abdominal binder. Data collection and analysis: Five electronic databases were searched until November 2019. Records were screened for eligibility. Data were extracted independently and analyzed. The main outcomes were pain and distress scores. Results: The final analysis included six RCTs. Overall effect estimate favored the abdominal binder group over the control group in the following outcomes: VAS pain scores after 24 hours (mean difference [MD] -1.76; 95% confidence interval [CI] -3.14 to -0.39; P=0.01), VAS scores after 48 hours (MD -1.21; 95% CI -1.51 to -0.90; P>0.001), distress score after 24 hours (MD -1.87; 95% CI -3.01 to -0.73; P=0.001), and distress score after 48 hours (MD -1.87; 95% CI -3.07 to -0.67; P=0.002). Conclusion: The abdominal binder could be an effective, simple, non-pharmacological option of relieving pain and distress after CD.
... These compression belts act by minimizing stress on the wound, reducing abdominal muscle activity during ambulation, improving overall mobility, and promoting deep breathing [17][18][19][20][21][22]. Compression may also prevent wound dehiscence and increase blood flow at the surgical site to promote healing and mitigate incision edema (seroma) [14,23,24]. Nevertheless, the evidence on the real effectiveness of abdominal binders is still lacking and their role in postpartum care remains unclear, as the majority of data derives from heterogeneous, small-scale studies. ...
The efficacy of abdominal binders in reducing postoperative pain and distress after cesarean delivery: A meta-analysis of randomized controlled trials
Article
Objective To evaluate the efficacy of abdominal binders in reducing postoperative pain, patient distress and surgical postoperative sequelae after cesarean delivery (CD). Methods A comprehensive search in electronic databases (MEDLINE, EMBASE, and Cochrane Central) was performed up to February 2021. Selection criteria included randomized clinical trials investigating the application or not of abdominal binder after CD. The primary outcome was postoperative pain, measured using the visual analog scale (VAS) pain score. Secondary outcomes were divided into short- and long-term postoperative outcomes, including patient distress, need for additional pain medications, time to mobilization, return to normal daily activities, surgical site infection, fascial dehiscence or incisional hernia, and rectus abdominis diastasis. The summary measures were reported as mean difference with 95 % confidence intervals (CI) using the random effects model of DerSimonian and Laird. An I² (Higgins I²) value of greater than 0% was used to identify heterogeneity. Results Four RCTs involving 601 women were included for meta-analysis: 310 (51.6 %) were randomized to the abdominal binder and 291 (48.4 %) to no abdominal binder group. There was no statistically significant difference between the two groups for VAS score either at 24 h (MD −0.97, 95 % CI −2.23 to 0.30; p = 0.13) and at 48 h (MD −0.30, 95 % CI −0.71 to 0.11; p = 0.15). Conversely, there was a significant reduction in postoperative distress (SDS) both at 24 h (MD −2.23, 95 % CI −3.77 to −0.70; p = 0.004) and 48 h (MD −2.37, 95 % CI −3.86 to −0.87; p = 0.002). Conclusion The present meta-analysis shows that the use of abdominal binders after CD significantly reduces patient distress.
... It has high morbidity especially long hospital stay as well as mortality up to 25%. 1 Wound dehiscence or burst abdomen is defined as separation of sutured edges of the abdominal fascia after surgery. 2 There are many factors which cause wound dehiscence like rupture of suture, knot failure, slack suture and suture cutting through the fascia but the most common cause of burst abdomen is the poor surgical technique of the surgeon closing the abdomen. 3 Midline wound dehiscence may be partial or complete. ...
Outcome of abdominal binder in midline abdominal wound Dehiscence in terms of pain, psychological satisfaction and need for reclosure
Article
Full-text available
  • May 2021
Objective: To assess the role of abdominal binder in patients with midline wound dehiscence after elective or emergency laparotomy in terms of pain, psychological satisfaction and need for reclosure. Methods: It was a comparative study done at EAST Surgical Ward of Mayo Hospital, Lahore from 1st January 2018 to 31st December 2019. One hundred and sixty-two (162) patients were included in this study with post-operative midline abdominal wound dehiscence and after informed consent by consecutive non probability sampling technique. Patients were divided into two groups by lottery method into eighty-one patients each. Group-A included patients where abdominal binder was applied and Group-B included patients without abdominal binder. In both groups pain score, psychological satisfaction and need for reclosure was assessed and compared. Results: Patients with abdominal binder shows significantly less pain (P value =0.000) and more psychological satisfaction (P value = 0.000) as compared to the patients where abdominal binder was not used. However, there was no difference in reducing the need for reclosure in patients who use abdominal binder (P value = 0.063). Conclusion: Although abdominal binder helps in reducing the pain and improving the psychological satisfaction in patients with midline abdominal wound dehiscence yet it doesn't help in healing of wound and reclosure of the dehisced abdominal wound is needed.
The Clinical Effects of Abdominal Binder on Abdominal Surgery: A Meta-analysis
Article
  • Nov 2020
Objective. We conducted a meta-analysis to quantitatively evaluate the effects of abdominal binder in abdominal surgeries. Methods. Through literature retrieval in globally recognized databases (MEDLINE, EMBASE, and Cochrane Central), trials investigating the application of abdominal binder in abdominal surgeries were systematically reviewed. The main outcomes, namely, 6-minute walk test (6MWT), visual analog scale (VAS) pain score, and symptom distress scale (SDS) score, were pooled to make an overall estimation. I ² index was calculated to identify heterogeneity, and sensitivity analysis was performed to validate the stability of main results and explore the source of heterogeneity. A funnel plot and Egger’s test were applied to assess publication bias. Results. Ten randomized controlled trials consisting of 968 subjects were ultimately included for the pooled estimation. Abdominal binder significantly increased the distance of 6MWT with standard mean difference (SMD) of .555 ( P < .001) and decreased the scores of VAS and SDS with SMD of −.979 ( P < .001) and −.716 ( P < .001), respectively. Despite of the significant heterogeneity indicated by I ² index statistic, the results of sensitivity analysis revealed the reliability of the main conclusions. While we identified no obvious publication bias regarding 6MWT (Egger’s test P = .321), it seemed that significant publication biases existed with respect to the estimation of VAS ( P < .001) and SDS ( P = .006). Conclusion. The current meta-analysis verified that abdominal binder efficiently promoted recovery after abdominal surgeries in terms of facilitating mobilization, alleviating pain, and reducing postoperative distress. More rigorously designed clinical trials with large sample size are expected to further elaborate its clinical value.
The effect of different types of abdominal binders on intra-abdominal pressure
Article
Full-text available
Objectives: To investigate the effect of non-elastic/elastic abdominal binders on intra-vesical pressure (IVP), physiological functions, and clinical outcomes in laparotomy patients at the perioperative stage. Methods: This prospective study was conducted from May to October 2014 at the Trauma Surgery Department, Daping Hospital, Chongqing, China. Laparotomy patients were randomly divided into non-elastic abdominal binder group (28 patients), and elastic abdominal binder group (29 patients). Binders were applied for 14 days following the operation, or until discharge. Demographic information, Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores (prior to the operation, on the first day after operation, the day IVP measurement was stopped, and one day before discharge), and outcomes were recorded. The IVP was measured before the operation to postoperative day 7. Results: There were no significant differences in the demographic information, outcomes, SOFA or APACHE-II scores between the 2 groups. Initial out-of-bed mobilization occurred earlier in the elastic binder group (3.2 ± 2.0 versus 5.0 ± 3.7 days, p=0.028). A greater increase in IVP was observed in the non-elastic binder group than in the elastic binder group (2.9 ± 1.1 versus 1.1 ± 0.7 mm Hg, p=0.000). Conclusion: Elastic binders have relatively little effect on IVP and are more helpful at promoting postoperative recovery than non-elastic binders. Therefore, elastic binders are more suitable for clinical use.
Abdominal binders after laparotomy: Review of the literature and French survey of policies
Article
Full-text available
  • Aug 2014
Background and aim: The use of abdominal binders after laparotomy is a question of habit. Scientific evidence of their usefulness is limited. The aims of this work were to review the scientific literature and to depict the practices of French surgeons regarding the use of these devices. Methods: A systematic review of the literature about the use of abdominal binders after laparotomy was conducted. In order to depict surgeons' habits, an anonymous questionnaire was sent to all surgical departments affiliated to the FRENCH network (Federation of Surgical Research) and their surgical contacts. They were all asked about their use of binders, the type of binders they ordered, the expected benefit, the cost and the need for a randomized trial in this field. Results: Only four trials have been published regarding the use of abdominal binders after laparotomy, all with a small number of patients. Some authors suggested that wearing binders procured a benefit in terms of postoperative comfort, but no significant difference was found. One study also suggested an improvement in respiratory volumes. No study focused on incisional hernia. Regarding the survey of practices, 50 questionnaires were retained for the final analysis (one questionnaire per department of surgery). The use of this device is really very frequent in France (94 % of surgeons order them), a habit usually acquired during the training in surgery. The main expected benefit is the prevention of abdominal wall dehiscence (83 %), but also an improvement in patients' postoperative comfort and pain (66 %). Although some surgeons order an abdominal binder for all their patients, most use them in selected patients (according to the operation and the patients' characteristics). Conclusion: Abdominal binders are frequently ordered by French surgeons after laparotomy. The expected benefit is the prevention of abdominal-wall complications, even though no data actually support this practice. Binders might have a benefit in terms of postoperative pain relief, but this needs to be analyzed. A prospective randomized trial is warranted.
The role of abdominal compliance, the neglected parameter in critically ill patients - A consensus review of 16. Part 1: Definitions and pathophysiology
Article
Full-text available
  • Nov 2014
Over the last few decades, increasing attention has been paid to understanding the pathophysiology, aetiology, prognosis, and treatment of elevated intra-abdominal pressure (IAP) in trauma, surgical, and medical patients. However, there is presently a relatively poor understanding of intra-abdominal volume (IAV) and the relationship between IAV and IAP (i.e. abdominal compliance). Consensus definitions on Cab were discussed during the 5th World Congress on Abdominal Compartment Syndrome and a writing committee was formed to develop this article. During the writing process, a systematic and structured Medline and PubMed search was conducted to identify relevant studies relating to the topic. According to the recently updated consensus definitions of the World Society on Abdominal Compartment Syndrome (WSACS), abdominal compliance (Cab) is defined as a measure of the ease of abdominal expansion, which is determined by the elasticity of the abdominal wall and diaphragm. It should be expressed as the change in IAV per change in IAP (mL [mm Hg]⁻¹). Importantly, Cab is measured differently than IAP and the abdominal wall (and its compliance) is only a part of the total abdominal pressure-volume (PV) relationship. During an increase in IAV, different phases are encountered: the reshaping, stretching, and pressurisation phases. The first part of this review article starts with a comprehensive list of the different definitions related to IAP (at baseline, during respiratory variations, at maximal IAV), IAV (at baseline, additional volume, abdominal workspace, maximal and unadapted volume), and abdominal compliance and elastance (i.e. the relationship between IAV and IAP). An historical background on the pathophysiology related to IAP, IAV and Cab follows this. Measurement of Cab is difficult at the bedside and can only be done in a case of change (removal or addition) in IAV. The Cab is one of the most neglected parameters in critically ill patients, although it plays a key role in understanding the deleterious effects of unadapted IAV on IAP and end-organ perfusion. The definitions presented herein will help to understand the key mechanisms in relation to Cab and clinical conditions and should be used for future clinical and basic science research. Specific measurement methods, guidelines and recommendations for clinical management of patients with low Cab are published in a separate review.
Disruption of the gastroesophageal junction by central obesity and waist belt: role of raised intra-abdominal pressure: Effect of obesity on the GE junction
Article
Full-text available
Obesity is a major reason for the recent increase in incidence of reflux disease and cancers at the distal esophagus and gastroesophageal junction (GOJ) and is mediated through a rise in the intra-abdominal pressure (IAP) but the exact mechanisms are unclear. Raised IAP from obesity and with application of waist belt produces mechanical distortion of the GOJ through formation of partial hiatus hernia. Even though there is no trans-sphincteric acid reflux, there is increased ingress of acid into the lower sphincter (intra-sphincteric reflux) as a consequence of raised IAP. In addition, short segment acid reflux is more evident in obese subjects with a belt on. Acid pocket is also enlarged in hiatus hernia, and acts as a reservoir of acid available to reflux whenever the sphincter fails. Above mechanisms may explain the common occurrence of cardiac lengthening and inflammation found in asymptomatic obese subjects. The inflamed cardia is also immunohistochemically similar to non-intestinal Barrett's mucosa, which is of etiological importance for cancers at the GOJ. Interventions that can reduce the mechanical distortion and acid exposure at the GOJ, including diet, exercise, drugs, sphincter augmentation therapy, and surgery, are clinically relevant in the treatment of gastroesophageal reflux disease but more data are needed whether if these strategies are also effective in preventing cancer. As a conclusion, raised IAP produces silent mechanical disruption of the GOJ, which may explain the high occurrence of cancers in this region and it is potentially reversible with early interventions.
Incarcerated spontaneous transdiaphragmatic intercostal hernia
Article
Full-text available
  • Dec 2011
Prolapse of abdominal viscera into the thoracic subcutis through the chest wall is known as transdiaphragmatic intercostal hernia (TIH). Herein, we present the first case of spontaneous TIH presenting as a thoracoabdominal emergency. A 78-year-old male presented with acute left thoracoabdominal pain following a sudden bulge at the left posterolateral chest wall corresponding to a partially reducible soft tissue mass with ecchymosis at the overlying skin. Paroxysmal cough during the last four days was also reported along with a prolonged daily application of a special tight abdominal belt that used while milking sheep. CT-scan of the abdomen showed intrathoracic proptosis of the splenic flexure through a defect of the left hemidiaphragm and subcutaneous prolapse of the herniated colon through the 7th intercostal space. On laparotomy, the herniated colon showed signs of ischemic necrosis leading to segmental colectomy followed by repair of the diaphragmatic defect. The clinical diagnosis of spontaneous TIH demands very high index of suspicion and thorough patient's history. In this case the daily elevation of the intraabdominal pressure due to an abdominal milking belt might have caused gradual slimming and loosening of the diaphragm and the intercostals muscles rendering them vulnerable to sudden increases of the thoracoabdominal pressure due to violent coughing. Such a hypothesis is reasonable in the absence of traumatic injury in this patient. Spontaneous TIH should be suspected in patients presenting with a sudden palpable chest wall bulge and associated thoracoabdominal symptoms in the absence of preceding injury.
The Effect of Abdominal Support on Functional Outcomes in Patients Following Major Abdominal Surgery: A Randomized Controlled Trial
Article
Full-text available
  • Jul 2010
Purpose: Immobility and pain are modifiable risk factors for development of venous thromboembolism and pulmonary morbidity after major abdominal surgery (MAS). The purpose of this study was to investigate the effect of abdominal incision support with an elasticized abdominal binder on postoperative walk performance (mobility), perceived distress, pain, and pulmonary function in patients following MAS. Methods: Seventy-five patients scheduled to undergo MAS via laparotomy were randomized to experimental (binder) or control (no binder) groups. Sixty (33 male, 27 female; mean age 58±14.9 years) completed the study. Preoperative measurements of 6-minute walk test (6MWT) distance, perceived distress, pain, and pulmonary function were repeated 1, 3, and 5 days after surgery. Results: Surgery was associated with marked postoperative reductions (p<0.001) in walk distance (∼75-78%, day 3) and forced vital capacity (35%, all days) for both groups. Improved 6MWT distance by day 5 was greater (p<0.05) for patients wearing a binder (80%) than for the control group (48%). Pain and symptom-associated distress remained unchanged following surgery with binder usage, increasing significantly (p<0.05) only in the no binder group. Conclusion: Elasticized abdominal binders provide a non-invasive intervention for enhancing recovery of walk performance, controlling pain and distress, and improving patients' experience following MAS.
A randomized-clinical trial examining a neoprene abdominal binder in gynecologic surgery patients
Article
Pain control and early ambulation are two important postoperative goals. Strategies that decrease morphine use while increasing ambulation have the potential to decrease postoperative complications. In this study the authors sought to determine the effect of an abdominopelvic binder on postoperative morphine use, pain, and ambulation in the first day after surgery. The authors randomly assigned 75 patients undergoing abdominal gynecologic surgery to either binder or not after surgery. Demographic data and surgical characteristics were collected. Outcome variables included morphine use, pain score, time to ambulation, and number of ambulations. A group at high risk for decreased mobility was identified and the binder increased the number of ambulatory events by 300%, 260%, and 240% in patients with vertical incisions, age over 50 years, and complex surgeries, respectively. Morphine use and pain scores were not significantly different. The binder increased ambulations in the subset of patients at the highest risk for postoperative complications: elderly, cancer patients, and vertical incisions. Routine use of the binder may benefit particularly high-risk gynecologic surgical patients.
Abdominal binders may reduce pain and improve physical function after major abdominal surgery – A systematic review
Article
  • Nov 2014
Introduction: Evidence for the effect of post-operative abdominal binders on post-operative pain, seroma formation, physical function, pulmonary function and increased intra-abdominal pressure among patients after surgery remains largely un-investigated. Methods: A systematic review was conducted. The PubMed, EMBASE and Cochrane databases were searched for studies on the use of abdominal binders after abdominal surgery or abdominoplasty. All types of clinical studies were included. Two independent assessors evaluated the scientific quality of the studies. The primary outcomes were pain, seroma formation and physical function. Results: A total of 50 publications were identified; 42 publications were excluded leaving eight publications counting a total of 578 patients for analysis. Generally, the scientific quality of the studies was poor. Use of abdominal binder revealed a non-significant tendency to reduce seroma formation after laparoscopic ventral herniotomy and a non-significant reduction in pain. Physical function was improved, whereas evidence supports a beneficial effect on psychological distress after open abdominal surgery. Evidence also supports that intra-abdominal pressure increases with the use of abdominal binders. Reduction of pulmonary function during use of abdominal binders has not been revealed. Conclusion: Abdominal binders reduce post-operative psychological distress, but their effect on post-operative pain after laparotomy and seroma formation after ventral hernia repair remains unclear. Due to the sparse evidence and poor quality of the literature, solid conclusions may be difficult to make, and procedure-specific, high-quality randomised clinical trials are warranted.
Intra-Abdominal Pressure: Why Are You Not Measuring It?*
Article
  • Feb 2014
The Effect of Abdominal Binders on Postoperative Pulmonary Function
Article
Abdominal binders are ordered by some surgeons postoperatively for patient comfort and to prevent wound complications. There has been some question as to the compressive effect that an abdominal binder has on pulmonary function. We prospectively randomized 54 patients undergoing a midline laparotomy incision to two groups: a "binder" group and a "no binder" group. Preoperative pulmonary function tests (vital capacity and incentive spirometry) were measured. Postoperatively, pulmonary function tests, pulse oximetry, oxygen requirement, pulmonary and wound complications, pain control, time to ambulation, and hospital length of stay were examined. Vital capacity as a per cent of preoperative values on postoperative Day 1 for the binder and nonbinder groups were 64.7 and 54.6 per cent, respectively, but this was not statistically significant. Average level of pain using the visual analog pain scale on postoperative Days 1 through 3 in the binder versus nonbinder groups was 4 versus 8, 3 vs 6, and 3 versus 7, respectively. Time to ambulation was 18.6 hours in the binder group and 16.7 hours in the nonbinder group. Hospital length of stay in the binder and nonbinder groups was 3.9 days and 3.7 days, respectively. We conclude that abdominal binders in our patients with midline abdominal incisions had no significant effect on postoperative pulmonary function, but seemed to help with pain control.