Open abdominal decompression (OAD) is a potentially life-saving but arguably invasive treatment for intra-abdominal hypertension (IAH) and/or abdominal compartment syndrome (ACS). Although OAD has previously been considered the only therapeutic option for IAH/ACS, the application of comprehensive nonoperative medical management strategies to reduce elevated intra-abdominal pressure and restore organ perfusion has recently been shown to decrease progression to ACS and the need for OAD. Furthermore, a variety of minimally invasive therapies have been developed for the treatment of patients who would traditionally have required OAD. In general, these therapies are most applicable for patients with secondary rather than primary IAH leading to ACS.