INTRODUCTION: To report our initial experience of laparostomy and immediate intra-abdominal vacuum therapy in patients with severe peritonitis due to intra-abdominal catastrophes. PATIENTS AND METHODS: Twenty-seven patients underwent emergency laparotomy and laparostomy formation with the application of immediate intra-abdominal TRAC-VAC therapy (male:female ratio, 1:1.2; median age, 73 years; range, 34-84 years). Predicted mortality was assessed using the P-POSSUM score and compared with clinically observed outcomes. RESULTS: Ten patients (37%) with a mean predicted P-POSSUM mortality of 72%, died of sepsis and multi-organ failure. Seventeen patients (mean P-POSSUM 48% expected mortality) survived to discharge. One patient with pancreatitis died from small bowel obstruction 1-year post discharge, two patients developed a small bowel fistula. One patient had an allergic reaction to the VAC dressing. Our patients, treated with laparostomy and TRAC VAC therapy, had a significantly improved observed survival when compared to P-POSSUM expected survival (P = 0.004). CONCLUSIONS: Laparostomy with immediate intraperitoneal VAC therapy is a robust and effective system to manage patients with intra-abdominal catastrophes. There were significantly improved outcomes compared to the mortality predicted by P-POSSUM scores. Damage control surgery with laparostomy formation and intra-abdominal VAC therapy should be considered in patients with severe peritonitis.
INTRODUCTION: To report our initial experience of laparostomy and immediate intra-abdominal vacuum therapy in patients with severe peritonitis due to intra-abdominal catastrophes. PATIENTS AND METHODS: Twenty-seven patients underwent emergency laparotomy and laparostomy formation with the application of immediate intra-abdominal TRAC-VAC therapy (male:female ratio, 1:1.2; median age, 73 years; range, 34-84 years). Predicted mortality was assessed using the P-POSSUM score and compared with clinically observed outcomes. RESULTS: Ten patients (37%) with a mean predicted P-POSSUM mortality of 72%, died of sepsis and multi-organ failure. Seventeen patients (mean P-POSSUM 48% expected mortality) survived to discharge. One patient with pancreatitis died from small bowel obstruction 1-year post discharge, two patients developed a small bowel fistula. One patient had an allergic reaction to the VAC dressing. Our patients, treated with laparostomy and TRAC VAC therapy, had a significantly improved observed survival when compared to P-POSSUM expected survival (P = 0.004). CONCLUSIONS: Laparostomy with immediate intraperitoneal VAC therapy is a robust and effective system to manage patients with intra-abdominal catastrophes. There were significantly improved outcomes compared to the mortality predicted by P-POSSUM scores. Damage control surgery with laparostomy formation and intra-abdominal VAC therapy should be considered in patients with severe peritonitis.
Authors: T Y Tang; S R Walsh; D R Prytherch; C Wijewardena; M E Gaunt; K Varty; J R Boyle Journal: Eur J Vasc Endovasc Surg Date: 2007-06-14 Impact factor: 7.069
Authors: Daniel Perez; Stefan Wildi; Nicolas Demartines; Matthias Bramkamp; Christian Koehler; Pierre-Alain Clavien Journal: J Am Coll Surg Date: 2007-10 Impact factor: 6.113
Authors: M López-Cano; J M García-Alamino; S A Antoniou; D Bennet; U A Dietz; F Ferreira; R H Fortelny; P Hernandez-Granados; M Miserez; A Montgomery; S Morales-Conde; F Muysoms; J A Pereira; R Schwab; N Slater; A Vanlander; G H Van Ramshorst; F Berrevoet Journal: Hernia Date: 2018-09-03 Impact factor: 4.739
Authors: Reinhold Kafka-Ritsch; Matthias Zitt; Nina Schorn; Sebastian Stroemmer; Stefan Schneeberger; Johann Pratschke; Alexander Perathoner Journal: World J Surg Date: 2012-08 Impact factor: 3.352
Authors: Reinhold Kafka-Ritsch; Franz Birkfellner; Alexander Perathoner; Helmut Raab; Hermann Nehoda; Johann Pratschke; Matthias Zitt Journal: J Gastrointest Surg Date: 2012-07-28 Impact factor: 3.452