Barker vacuum pack can be used to perform a temporary abdominal closure (TAC) or open abdomen (OA) as part of damage control surgical (DCS) interventions in trauma, peritonitis or pancreatitis and generally in all those conditions at risk of intra-abdominal pressure (IAP) increase.
It allows the frequent reassessment of intra-abdominal content. It is used to prevent or to treat the intra-abdominal hypertension (IAH) or the abdominal compartment syndrome (ACS). The technique is simple and easily available.
It is realized with a fenestrated, non-adherent polyethylene sheet placed inside the abdomen to protect the bowel and to prevent adhesions formation with the peritoneum, covered by moist surgical towels or gauze. 2 large silicone drains are positioned over the gauzes, and finally a transparent adhesive drape is put over the wound to seal the abdominal cavity. The drains are connected to continuous wall suction at 100 to 150 mm Hg. The dressing system is usually changed every 24 to 48 hours. At each change the abdominal wall edges can be approximated with interrupted stitches to prevent fascial retraction. This maneuver should be done paying attention to prevent excessive tension. Some centers use this technique for the first 24 to 48 hours after surgery, switching to more sophisticated NPT systems afterward if the abdomen could not be closed. This technique could partially preserve the abdominal wall domain.
Its major disadvantages are the impossibility to assess the intra-abdominal content without re-open the abdomen and the impossibility of an effective removal of infected or toxin- and cytokine-rich intra-peritoneal fluid.