Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis

OBJECTIVE: to present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. METHODS: we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years); 11 patients were male, and four were female. RESULTS: forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. CONCLUSION: the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.

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Temporary abdominal closure for trauma and intra-abdominal sepsis

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000001283 ◽

2017 ◽

Vol 82 (2) ◽

pp. 345-350 ◽

Cited By ~ 14

Author(s):

Tyler J. Loftus ◽

Janeen R. Jordan ◽

Chasen A. Croft ◽

R. Stephen Smith ◽

Philip A. Efron ◽

...

Keyword(s):

Abdominal Sepsis ◽

Temporary Abdominal Closure ◽

Abdominal Closure

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Open Abdomen Management and Candida Infections: A Very Likely Link

Gastroenterology Research and Practice ◽

10.1155/2017/5187620 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Savino Occhionorelli ◽

Monica Zese ◽

Rosario Cultrera ◽

Domenico Lacavalla ◽

Marco Albanese ◽

...

Keyword(s):

Antifungal Therapy ◽

Open Abdomen ◽

Case Series ◽

Abdominal Sepsis ◽

Temporary Abdominal Closure ◽

Retrospective Case ◽

Abdominal Closure ◽

Closure Duration ◽

Abdominal Hypertension ◽

Significant Difference

Objective. Laparostomy can be applied in trauma, abdominal sepsis, intra-abdominal hypertension, or compartment syndrome. Systemic infections, especially if complicated by Candida, are associated with a high risk of mortality. Methods. This is a single-centre retrospective case series of 47 cases admitted to our Department, which required laparostomy procedure; we analyzed the type of surgery, temporary abdominal closure, duration of open abdomen, complications, SOFA score, mortality with Candida infections, and empirical or targeted antifungal therapy. Results. We found that patients with Candida infection were related with a statistically significant difference (p<0.05) with a complication after OA closure, total complications, time elapsed after OA application, time spent on the first surgical OA application, type of temporary abdominal closure that is used, and duration of the open abdomen. The use of empirical and targeted antifungal therapy is related to the duration of open abdomen too. Conclusions. Management of the OA is often burdened by sepsis or septic shock, especially when complicated by Candida infection. Candida score is a validated tool to identify patients who can be treated empirically, but every situation must be considered on an individual basis.

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Use of the “Bogota Bag” for Temporary Abdominal Closure in Patients with Secondary Peritonitis

The American Surgeon ◽

10.1177/000313480707300310 ◽

2007 ◽

Vol 73 (3) ◽

pp. 249-252 ◽

Cited By ~ 10

Author(s):

Boris Kirshtein ◽

Aviel Roy-Shapira ◽

Leonid Lantsberg ◽

Solly Mizrahi

Keyword(s):

Abdominal Sepsis ◽

Secondary Peritonitis ◽

Fistula Formation ◽

Temporary Abdominal Closure ◽

Abdominal Closure ◽

Flap Repair ◽

Abdominal Operations ◽

Secondary Closure ◽

Postoperative Problems ◽

Temporary Closure

Various methods may be used for temporary closure of the abdomen. Use of the “Bogota bag” (BB) technique for abdominal closure has been reported primarily in the management of injuries. This review describes our experience using the BB technique in cases of secondary peritonitis. Abdomenal closure using BB was reviewed retrospectively in 152 patients with secondary peritonitis. Of the 152 cases of BB use reviewed, 79 patients had complications of previous abdominal operations, 57 had secondary peritonitis, 14 had complications of abdominal trauma, and 2 were cases of mesenteric events. The BB remained in situ from 1 to 19 days. Changes occurred between 1 and 11 times per patient (mean, 2.8). In nine patients, early diagnosis of leaking of small bowel content under the bag was noted, and 36 patients (24%) died from sepsis. In 12 patients, the resolution of abdominal sepsis permitted secondary closure 10 days later. In 16 patients, mesh repair was performed after 4 weeks. Musculocutaneal flap repair was used in one case, and 13 patients had skin grafts. Eleven patients eventually underwent ventral hernia repair. Early temporary closure of the abdominal wall using BB in patients with abdominal sepsis and planned re-explorations is simple, safe, inexpensive, and effective. This temporary abdominal cover provides good exposure of abdominal content between re-explorations and may prevent fistula formation. The development and subsequent repair of large hernias constitute one of the difficult postoperative problems requiring future solution.

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Cost evaluation of temporary abdominal closure methods in abdominal sepsis patients successfully treated with an open abdomen. Should we take temporary abdominal closure methods at face value? Health economic evaluation

Annals of Medicine and Surgery ◽

10.1016/j.amsu.2020.06.007 ◽

2020 ◽

Vol 56 ◽

pp. 11-16

Author(s):

Alfredo Sanchez Betancourt ◽

Gonzalez Cole Milagros ◽

Pablo Sibaja ◽

Luis Fernandez ◽

Scott Norwood

Keyword(s):

Health Economic ◽

Economic Evaluation ◽

Open Abdomen ◽

Health Economic Evaluation ◽

Abdominal Sepsis ◽

Cost Evaluation ◽

Temporary Abdominal Closure ◽

Abdominal Closure

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Open Abdomen in Trauma and Critical Care

Critical Care Nurse ◽

10.4037/ccn2017294 ◽

2017 ◽

Vol 37 (5) ◽

pp. 22-45 ◽

Cited By ~ 6

Author(s):

Eleanor R. Fitzpatrick

Keyword(s):

Critical Care ◽

Open Abdomen ◽

Damage Control ◽

Management Strategies ◽

Damage Control Surgery ◽

Standard Of Care ◽

Trauma Patients ◽

Temporary Abdominal Closure ◽

Abdominal Closure ◽

Planned Reoperation

The open abdomen technique and temporary abdominal closure after damage control surgery is fast becoming the standard of care for managing intra-abdominal bleeding and infectious or ischemic processes in critically ill patients. Expansion of this technique has evolved from damage control surgery in severely injured trauma patients to use in patients with abdominal compartment syndrome due to acute pancreatitis and other disorders. Subsequent therapies after use of the open abdomen technique and temporary abdominal closure are resuscitation in the intensive care unit and planned reoperation to manage the underlying cause of bleeding, infection, or ischemia. Determining the need for this potentially lifesaving intervention and managing the wound after the open abdomen has been created are all within the realm of critical care nurses. Case studies illustrate the implementation of the open abdomen technique and patient management strategies.

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Hand Infections: An Audit of 160 Infections Treated in an Accident and Emergency Department

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(93)90208-w ◽

1993 ◽

Vol 18 (1) ◽

pp. 115-118 ◽

Cited By ~ 16

Author(s):

J. STEVENSON ◽

I. W. R. ANDERSON

Keyword(s):

Emergency Department ◽

Complete Resolution ◽

Wound Care ◽

Duration Of Treatment ◽

Mean Delay ◽

Accident And Emergency ◽

Accident And Emergency Department ◽

The Mean ◽

Careful Assessment

160 consecutive hand infections presented to an Accident and Emergency department over a four-month period. All but one were treated solely on an out-patient basis. The mean delay to presentation was three days, the mean duration of treatment was six days. Follow-up to complete resolution was achieved in 89% of cases. No patients were treated with parenteral antibiotics. The need for careful assessment, early aggressive surgery, and meticulous attention to the principles of wound care by experienced clinicians is emphasized.

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Quantifying the Risk of Methicillin-Resistant Staphylococcus aureus (MRSA) Transmission From Patient to Healthcare Personnel in the Critical Care Setting

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.989 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s364-s364

Author(s):

Timileyin Adediran ◽

Anthony Harris ◽

J. Kristie Johnson ◽

Mary-Claire Roghmann ◽

Stephanie Hitchcok ◽

...

Keyword(s):

Patient Care ◽

Wound Care ◽

Medical Center ◽

Glucose Monitoring ◽

Routine Care ◽

Healthcare Personnel ◽

Medication Delivery ◽

Care Activity ◽

The Mean ◽

Specific Care

Background: Healthcare personnel (HCP) acquire MRSA on their gown and gloves during routine care activities for patients who are colonized or infected with MRSA at a rate of ∼15%. Certain care activities (eg, physical exam, care of endotracheal tube, wound care and bathing/hygiene) have been associated with a higher frequency of transmission from the patient to HCP gown and gloves than other activities (ie, administration of oral medicines, glucose monitoring, and manipulation of IV tubing/medication delivery). However, quantification of MRSA contamination and risk to subsequent patients is poorly defined. Objective: We sought to determine the mean MRSA colony-forming units (CFU) found on the gloves and gowns of HCP who acquire MRSA after various care activities involving patients with MRSA. Methods: We conducted a prospective cohort study at the University of Maryland Medical Center from December 2018 to October 2019. We identified patients colonized or infected with MRSA based on culture data from the prior 7 days. HCP performing prespecified care activities on eligible patients were observed. To isolate the risk of each care activity, HCP donned new gloves and gown prior to a specific care activity. Once that care activity was performed, HCP gloves and gown were swabbed prior to the any further care activities. HCP gloves were cultured with an E-swab by swabbing each digit up and down 3 times followed by 2 circles on the palm of their hands. HCP gowns were sampled by swabbing a 15 × 30-cm area along the beltline of the gown and along each inner forearm twice. E-swab liquid was then serially diluted and plated in triplicate on CHROMagar MRSA II (BD, Sparks, MD) to obtain CFU. We calculated the median CFUs and the interquartile range (IQR) for each specific care activity stratified by gown and gloves. Results: In total, 604 HCP–patient care interactions were observed. Table 1 displays the mean MRSA CFUs stratified by gown and gloves for each patient care activity of interest. Conclusions: The quantity of MRSA found on gowns and gloves varies depending on patient care activities. Recognition of differential transmission rates between various activities may allow different approaches to infection prevention, such as the use of personal protective equipment in high- versus low-risk activities and/or the use of more aggressive interventions for high-risk activities.Funding: NoneDisclosures: None

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