scholarly journals Lessons Learned in 11 Years of Experience With Open Abdomen Treatment With Negative-Pressure Therapy for Various Abdominal Emergencies

2021 ◽  
Vol 8 ◽  
Author(s):  
Elisabeth Gasser ◽  
Daniel Rezaie ◽  
Johanna Gius ◽  
Andreas Lorenz ◽  
Philipp Gehwolf ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Open Abdomen ◽  
Bowel Perforation ◽  
Fistula Formation ◽  
Perforated Diverticulitis ◽  
Negative Pressure Therapy ◽  
Burst Abdomen ◽  
Pressure Therapy ◽  
Abdominal Emergencies ◽  
Fascia Closure

Introduction: Open abdomen (OA) treatment with negative-pressure therapy (NPT) was initiated for perforated diverticulitis and subsequently extended to other abdominal emergencies. The aim of this retrospective study was to analyze the indications, procedures, duration of NPT, and the outcomes of all our patients.Methods: All consecutive patients treated with intra-abdominal NPT from January 1, 2008 to December 31, 2018 were retrospectively analyzed.Results: A total of 438 patients (44% females) with a median (range) age of 66 (12–94) years, BMI of 25 (14–48) kg/m2, and ASA class I, II, III, and IV scores of 36 (13%), 239 (55%), 95 (22%), and 3(1%), respectively, were treated with NPT. The indication for surgery was primary bowel perforation in 163 (37%), mesenteric ischemia in 53 (12%), anastomotic leakage in 53 (12%), ileus in 53 (12%), postoperative bowel perforation/leakage in 32 (7%), abdominal compartment in 15 (3%), pancreatic fistula in 13 (3%), gastric perforation in 13 (3%), secondary peritonitis in 11 (3%), burst abdomen in nine (2%), biliary leakage in eight (2%), and other in 15 (3%) patients. A damage control operation without reconstruction in the initial procedure was performed in 164 (37%) patients. The duration of hospital and intensive care stay were, median (range), 28 (0–278) and 4 (0–214) days. The median (range) duration of operation was 109 (22–433) min and of NPT was 3(0–33) days. A trend to shorter duration of NPT was observed over time and in the colonic perforation group. The mean operating time was shorter when only blind ends were left in situ, namely 110 vs. 133 min (p = 0.006). The mortality rates were 14% at 30 days, 21% at 90 days, and 31% at 1 year. An entero-atmospheric fistula was observed in five (1%) cases, most recently in 2014. Direct fascia closure was possible in 417 (95%) patients at the end of NPT, but least often (67%, p = 0.00) in patients with burst abdomen. During follow-up, hernia repair was observed in 52 (24%) of the surviving patients.Conclusion: Open abdomen treatment with NPT is a promising concept for various abdominal emergencies, especially when treated outside normal working hours. A low rate of entero-atmospheric fistula formation and a high rate of direct fascia closure were achieved with dynamic approximation of the fascia edges. The authors recommend an early-in and early-out strategy as the prolongation of NPT by more than 1 week ends up in a frozen abdomen and does not improve abdominal sepsis.

scholarly journals Treatment of the open abdomen with topical negative pressure therapy: a retrospective study of 46 cases

2011 ◽  
Vol 8 (3) ◽  
pp. 274-279 ◽  
Author(s):  
Aleidis Caro ◽  
Carles Olona ◽  
Andrea Jiménez ◽  
Jordi Vadillo ◽  
Francesc Feliu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Negative Pressure ◽  
Open Abdomen ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
Topical Negative Pressure

scholarly journals Damage control surgery for grade IV blunt hepatic injury with multiple organ damage in a child: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Jun Soma ◽  
Daisuke Ishii ◽  
Hisayuki Miyagi ◽  
Seiya Ishii ◽  
Keita Motoki ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Hepatic Injury ◽  
Open Abdomen ◽  
Damage Control ◽  
Organ Damage ◽  
Multiple Organ ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
Neurological Sequelae ◽  
Blunt Hepatic Injury

Abstract Background Intra-abdominal hemorrhage caused by blunt hepatic injury is a major cause of morbidity and mortality in patients with abdominal trauma. Some of these patients require laparotomy, and rapid decision-making and life-saving surgery are essential. Damage control (DC) surgery is useful for treating children in critical situations. We performed this technique to treat an 8-year-old boy with grade IV blunt hepatic injury and multiple organ damage. This is the first report of the use of the ABTHERA Open Abdomen Negative Pressure Therapy System (KCI, now part of 3 M Company, San Antonio, TX, USA) for DC surgery to rescue a patient without neurological sequelae. Case presentation An 8-year-old boy was brought to the emergency department of our hospital after being run over by a motor vehicle. He had grade IV blunt hepatic injury, thyroid injury, and bilateral hemopneumothorax. Although he was hemodynamically stable, the patient’s altered level of consciousness, the presence of a sign of peritoneal irritation, and suspicion of intestinal injury led us to perform exploratory laparotomy. As part of a DC strategy, we performed gauze packing to control hemorrhage from the liver and covered the abdomen with an ABTHERA Open Abdomen Negative Pressure Therapy System to improve the patient’s general condition. Eighteen days after admission, the patient was diagnosed with a biliary fistula, which improved with percutaneous and external drainage. He had no neurological sequelae and was discharged 102 days after injury. Conclusion The DC strategy was effective in children with severe blunt hepatic injury. We opted to perform DC surgery because children have less hemodynamic reserve than adults, and we believe that using this strategy before the appearance of trauma triad of death could save lives and improve outcomes. During conservative management, it is important to adopt a multistage, flexible approach to achieve a good outcome.

A new technique to close open abdomen using negative pressure therapy and elastic gums

Injury ◽  
2016 ◽  
Vol 47 (4) ◽  
pp. 979-982
Author(s):  
Rosa María Jiménez-Rodríguez ◽  
Felipe Pareja Ciuró ◽  
Virginia Durán Muñoz Cruzado ◽  
Mercedes Flores Cortes ◽  
Francisco López Bernal ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Open Abdomen ◽  
New Technique ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
A New Technique

Should Negative Pressure Therapy Replace Any Other Temporary Abdominal Closure Device in Open-Abdomen Management of Secondary Peritonitis?

2021 ◽  
Author(s):  
Vincenzo Pappalardo ◽  
Stefano Rausei ◽  
Vincenzo Ardita ◽  
Luigi Boni ◽  
Gianlorenzo Dionigi
Keyword(s):  
Negative Pressure ◽  
Open Abdomen ◽  
Secondary Peritonitis ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
Advantages And Disadvantages ◽  
Abdominal Closure ◽  
Primary Fascial Closure

AIM: To clarify the advantages of negative pressure therapy (NPT) compared to other methods of temporary abdominal closure (TAC) in the management of secondary peritonitis. METHODS: We retraced the history of known methods of TAC, and analyzed their advantages and disadvantages. We evaluated as the NPT mechanisms, both from the macroscopic that bio-molecular point of view, well suits to manage this difficult condition. RESULTS: The ideal TAC technique should be quick to apply, easy to change, protect and contain the abdominal viscera, decrease bowel edema, prevent loss of domain and abdominal compartment syndrome, limit contamination, allow egress of peritoneal fluid (and its estimation) and not result in adhesions. It should also be cost-effective, minimize the number of dressing changes and the number of surgical revisions, and ensure a high rate of early closure with a low rate of complications (especially entero-atmospheric fistula). For NPT, the reported fistula rate is 7%, primary fascial closure ranges from 33 to 100% (average 60%) and the mortality rate is about 20%. With the use of NPT as TAC, it may be possible to extend the window of time to achieve primary fascial closure (for up to 20-40 days). CONCLUSION: NPT has several potential advantages in open-abdomen (OA) management of secondary peritonitis and may make it possible to achieve all the goals suggested above for an ideal TAC system. Only trained staff should use NPT, following the manufacturer’s instructions when commercial products are used. Even if there was a significant evolution in OA management, we believe that further research into the role of NPT for secondary peritonitis is necessary.

Treatment of small-bowel fistulae in the open abdomen with topical negative-pressure therapy

2011 ◽  
Vol 202 (2) ◽  
pp. e20-e24 ◽  
Author(s):  
Mathieu D'Hondt ◽  
Dirk Devriendt ◽  
Frank Van Rooy ◽  
Franky Vansteenkiste ◽  
André D'Hoore ◽  
...  
Keyword(s):  
Small Bowel ◽  
Negative Pressure ◽  
Open Abdomen ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
Topical Negative Pressure

Pressure at the Bowel Surface during Topical Negative Pressure Therapy of the Open Abdomen: An Experimental Study in a Porcine Model

2011 ◽  
Vol 35 (4) ◽  
pp. 917-923 ◽  
Author(s):  
Thordur Bjarnason ◽  
Agneta Montgomery ◽  
Joanna Hlebowicz ◽  
Sandra Lindstedt ◽  
Ulf Petersson
Keyword(s):  
Experimental Study ◽  
Negative Pressure ◽  
Porcine Model ◽  
Open Abdomen ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
Topical Negative Pressure

scholarly journals P109 MANAGEMENT OF THE OPEN ABDOMEN WITH COMBINED THERAPIES. HOW TO AVOID VENTRAL HERNIAS AND BE ABLE TO PERFORM THE REPAIR OF THE ABDOMINAL WALL IN A DEFINITIVE WAY

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Miguel Aguirre
Keyword(s):  
Abdominal Wall ◽  
Negative Pressure ◽  
Open Abdomen ◽  
Abdominal Sepsis ◽  
Fascial Closure ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
Definitive Repair ◽  
Ventral Hernias ◽  
Primary Fascial Closure

Abstract Aim To demonstrate that in patients with abdominal sepsis, delayed primary fascial closure and definitive abdominal wall repair can be achieved, in the same hospitalization, using combined therapies, which reduces the percentage of ventral hernias. Material and Methods Medical records, tomography images and outpatient controls of 9 patients were reviewed, which required open abdomen management for abdominal sepsis using negative pressure therapy combined with a dynamic fascial mesh traction, from February 2020 until May 2021. Results 9 patients (2 men and 7 women), all Grade 2C open abdomen according to Björck clasification, with a median age of 43 years (25-71). The median time therapy was 29±3 days. The primary fascial closure rate was 100% (n = 9), 77.8% (n = 7) underwent a definitive repair of the abdominal wall with absorbable synthetic mesh in the same hospitalization, while 22.2% (n = 2) did not, due to being cancer patients. The mortality rate was 11.1% (n = 1) due to pneumonia and the fistula rate was 11.1% (n = 1). None developed an incisional hernia at the one-year follow-up. Conclusions The combination of negative pressure therapy with dynamic fascial mesh traction, in the management of the open abdomen, allows us to achieve a 100% delayed primary fascial closure, avoiding ventral hernia. In the same hospitalization, while the patient leaves the critical stage, we can achieve a definitive repair of the abdominal wall using absorbable synthetic meshes returning the biomechanics to the abdominal wall, improving the quality of life of these patients.

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