Surgical treatmentDecompressive laparotomy is the definitive treatment for ACS [34]. The technique can be invasive (midline laparotomy) or minimally invasive (endoscopic techniques based on subcutaneous anterior abdominal fasciotomy). This intervention results in a laparostomy or open abdomen so that a temporary abdominal closure is needed (moist gauze, towel clip closure, Bogota bag, Wittman patch or zipper, home-made system, or vacuum-assisted closure). Figure 3 shows a surgical treatment algorithm.