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Open abdomen and VAC® in severe diffuse peritonitis
  1. Ventsislav M Mutafchiyski1,
  2. G I Popivanov2,
  3. K T Kjossev3 and
  4. S Chipeva4
  1. 1Department of Military Surgery, Clinic of Endoscopic, Endocrine surgery and Coloproctology, Military Medical Academy, Sofia, Bulgaria
  2. 2Clinic of Endoscopic, Endocrine surgery and Coloproctology, Military Medical Academy, Sofia, Bulgaria
  3. 3Clinic of Abdominal Surgery, Military Medical Academy, Sofia, Bulgaria
  4. 4Department of Statistics and Econometrics, University of National and World Economy, Sofia, Bulgaria
  1. Correspondence to G I Popivanov, General Surgeon, Military Medical Academy, 3 “Georgi Sofijski” Str., Sofia 1606, Bulgaria; gerasimpopivanov{at}rocketmail.com

Abstract

Background Currently, the open abdomen technique is the widely recognised method for treatment of life-threatening trauma, intra-abdominal sepsis, abdominal compartment syndrome and wound dehiscence. The techniques for temporary closure using negative pressure have gained increasing popularity. Although negative pressure wound therapy has been proved as an effective method in trauma, the results in diffuse peritonitis are contradictory.

Methods Overall, 108 patients with diffuse peritonitis and open abdomen were prospectively enrolled from January 2006 to December 2013—69 treated with mesh-foil laparostomy without negative pressure and 49 with vacuum-assisted closure (VAC®) The primary endpoints were the rate of primary fascial closure and mortality. The secondary outcomes were the rate of complications—enteroatmospheric fistulas, intra-abdominal abscesses, wound infection and necrotising fasciitis, intensive care unit (ICU) and overall hospital stay.

Results VAC was associated with higher overall (73% vs 53%) and late primary fascial closure rates (31% vs 7%), lower rates of necrotising fasciitis (2% vs 15%, p=0.012), intra-abdominal abscesses (10% vs 20%), enteroatmospheric fistulas (8% vs 19%), overall mortality (31% vs 53%, p<0.05), shorter ICU (6.1 vs 10.6 days, p=0.002) and hospital stay (15.1 vs 25.9 days, p=0.000).

Conclusions The results clearly suggest the obvious advantage of VAC in comparison to the temporary abdominal closure without negative pressure in the cases with severe diffuse peritonitis. However, to a large extent, our results might be attributed to the combination of VAC with dynamic fascial closure.

  • SURGERY
  • WOUND MANAGEMENT

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