Matti Tolonen1, Panu Mentula, Ville Sallinen, Suvi Rasilainen, Minna Bäcklund, Ari Leppäniemi. 1. From the Department of Abdominal Surgery, Abdominal Center (M.T., P.M., V.S., S.R., A.L.), Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Transplantation and Liver Surgery, Abdominal Center (V.S.), Helsinki University Hospital and University of Helsinki, Helsinki, Finland; and Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine(M.B.), Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Abstract
BACKGROUND: Open abdomen (OA) treatment in patients with peritonitis is increasing worldwide. Various temporary abdominal closure devices are being used. This study included patients with complicated diffuse secondary peritonitis, OA, and vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM). The aim of this study was to describe mortality and major morbidity in terms of delayed primary fascial closure and enteroatmospheric fistula rates. METHODS: This was a single-academic-center retrospective study of consecutive patients with diffuse peritonitis, OA, and VAWCM between years 2008 and 2016. Descriptive and univariate analyses were performed. RESULTS: Forty-one patients were identified and analyzed. Median age was 59 years, preoperative septic shock was diagnosed in 54% (n = 22), and 59% (n = 24) had a postoperative peritonitis. Mortality was 29% (n = 12), and 76% (n = 31) of patients were admitted in the intensive care unit. The median duration of OA was 7 days with a median of two dressing changes. Delayed primary fascial closure rate among survivors was 92% (n = 33), and enteroatmospheric fistulas developed in 7% (n = 3). In a subgroup analysis, patients with OA in the primary laparotomy for peritonitis (n = 27) were compared with patients with OA in the subsequent laparotomies (n = 14). There were no significant differences between groups. CONCLUSIONS: The VAWCM technique in patients with complicated secondary diffuse peritonitis and OA yields excellent results in terms of delayed primary fascial closure rate and a low number of enteroatmospheric fistulas. It seems to be safe to close the abdomen at the index laparotomy, if possible, even if there is a risk of a need of OA later. LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.
BACKGROUND: Open abdomen (OA) treatment in patients with peritonitis is increasing worldwide. Various temporary abdominal closure devices are being used. This study included patients with complicated diffuse secondary peritonitis, OA, and vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM). The aim of this study was to describe mortality and major morbidity in terms of delayed primary fascial closure and enteroatmospheric fistula rates. METHODS: This was a single-academic-center retrospective study of consecutive patients with diffuse peritonitis, OA, and VAWCM between years 2008 and 2016. Descriptive and univariate analyses were performed. RESULTS: Forty-one patients were identified and analyzed. Median age was 59 years, preoperative septic shock was diagnosed in 54% (n = 22), and 59% (n = 24) had a postoperative peritonitis. Mortality was 29% (n = 12), and 76% (n = 31) of patients were admitted in the intensive care unit. The median duration of OA was 7 days with a median of two dressing changes. Delayed primary fascial closure rate among survivors was 92% (n = 33), and enteroatmospheric fistulas developed in 7% (n = 3). In a subgroup analysis, patients with OA in the primary laparotomy for peritonitis (n = 27) were compared with patients with OA in the subsequent laparotomies (n = 14). There were no significant differences between groups. CONCLUSIONS: The VAWCM technique in patients with complicated secondary diffuse peritonitis and OA yields excellent results in terms of delayed primary fascial closure rate and a low number of enteroatmospheric fistulas. It seems to be safe to close the abdomen at the index laparotomy, if possible, even if there is a risk of a need of OA later. LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.
Authors: Daniel Jonathan Gross; Michael C Smith; Bardiya Zangbar-Sabegh; Kenneth Chao; Erin Chang; Leon Boudourakis; Muthukumar Muthusamy; Valery Roudnitsky; Tim Schwartz Journal: Trauma Surg Acute Care Open Date: 2019-12-31
Authors: Miklosh Bala; Jeffry Kashuk; Ernest E Moore; Yoram Kluger; Walter Biffl; Carlos Augusto Gomes; Offir Ben-Ishay; Chen Rubinstein; Zsolt J Balogh; Ian Civil; Federico Coccolini; Ari Leppaniemi; Andrew Peitzman; Luca Ansaloni; Michael Sugrue; Massimo Sartelli; Salomone Di Saverio; Gustavo P Fraga; Fausto Catena Journal: World J Emerg Surg Date: 2017-08-07 Impact factor: 5.469
Authors: Federico Coccolini; Derek Roberts; Luca Ansaloni; Rao Ivatury; Emiliano Gamberini; Yoram Kluger; Ernest E Moore; Raul Coimbra; Andrew W Kirkpatrick; Bruno M Pereira; Giulia Montori; Marco Ceresoli; Fikri M Abu-Zidan; Massimo Sartelli; George Velmahos; Gustavo Pereira Fraga; Ari Leppaniemi; Matti Tolonen; Joseph Galante; Tarek Razek; Ron Maier; Miklosh Bala; Boris Sakakushev; Vladimir Khokha; Manu Malbrain; Vanni Agnoletti; Andrew Peitzman; Zaza Demetrashvili; Michael Sugrue; Salomone Di Saverio; Ingo Martzi; Kjetil Soreide; Walter Biffl; Paula Ferrada; Neil Parry; Philippe Montravers; Rita Maria Melotti; Francesco Salvetti; Tino M Valetti; Thomas Scalea; Osvaldo Chiara; Stefania Cimbanassi; Jeffry L Kashuk; Martha Larrea; Juan Alberto Martinez Hernandez; Heng-Fu Lin; Mircea Chirica; Catherine Arvieux; Camilla Bing; Tal Horer; Belinda De Simone; Peter Masiakos; Viktor Reva; Nicola DeAngelis; Kaoru Kike; Zsolt J Balogh; Paola Fugazzola; Matteo Tomasoni; Rifat Latifi; Noel Naidoo; Dieter Weber; Lauri Handolin; Kenji Inaba; Andreas Hecker; Yuan Kuo-Ching; Carlos A Ordoñez; Sandro Rizoli; Carlos Augusto Gomes; Marc De Moya; Imtiaz Wani; Alain Chichom Mefire; Ken Boffard; Lena Napolitano; Fausto Catena Journal: World J Emerg Surg Date: 2018-02-02 Impact factor: 5.469