Open abdomen and VAC® in severe diffuse peritonitis

• Published in: BMJ military health 2016-02, Vol.162 (1), p.30-34
• Main Authors: Mutafchiyski, Ventsislav M, Popivanov, G I, Kjossev, K T, Chipeva, S
• Format: Article
• Language: English
• Subjects: Adult; Aged; Fasciitis, Necrotizing; Female; Humans; Laparotomy; Length of Stay; Male; Middle Aged; Negative-Pressure Wound Therapy - adverse effects; Negative-Pressure Wound Therapy - methods; Negative-Pressure Wound Therapy - statistics & numerical data; Peritonitis - epidemiology; Peritonitis - surgery; Postoperative Complications - epidemiology; Prospective Studies
• ISSN: 0035-8665; 2633-3767; 2052-0468; 2633-3775
• DOI: 10.1136/jramc-2014-000386

BackgroundCurrently, 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.MethodsOverall, 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.ResultsVAC 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