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.

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.

scholarly journals P110 MANAGEMENT OF THE OPEN ABDOMEN WITH COMBINED THERAPIES. HOW TO AVOID THE VENTRAL HERNIA 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 ◽  
Ventral Hernia ◽  
Negative Pressure ◽  
Open Abdomen ◽  
Abdominal Sepsis ◽  
Fascial Closure ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
Definitive Repair ◽  
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.

The open abdomen

2021 ◽  
pp. 1179-1184
Author(s):  
Omar A. Khan ◽  
Emma Rose McGlone ◽  
Marcus Reddy
Keyword(s):  
Negative Pressure ◽  
Open Abdomen ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Temporary Abdominal Closure ◽  
Systemic Complications ◽  
Advantages And Disadvantages ◽  
Abdominal Closure ◽  
Local And Systemic Complications ◽  
Abdominal Compartment

This chapter introduces the concept of the open abdomen and describes the various aetiologies of this complex condition, including the rationale for elective laparostomy in damage control surgery and as a treatment for abdominal compartment syndrome. The significance of the open abdomen is described in terms of its local and systemic complications, which form the basis of the established classification. Important considerations in the acute systemic management of patients with this condition are outlined, and methods of temporary abdominal closure are described. Advantages and disadvantages of these alternatives, including the use of negative-pressure wound therapy, are discussed.

scholarly journals Open abdomen treatment with negative pressure wound therapy at department for abdominal surgery, UCC Maribor: Our experiences and results

2016 ◽  
Vol 63 (1) ◽  
pp. 121-123
Author(s):  
Bojan Krebs
Keyword(s):  
Abdominal Surgery ◽  
Negative Pressure ◽  
Open Abdomen ◽  
Abdominal Cavity ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Pressure System ◽  
Abdominal Closure ◽  
Primary Surgery ◽  
Better Than

Introduction: With the development of modern surgery we often come to situation where, after the procedure, closing of abdomen is not feasable. There are many techniques of temporary abdominal closure but best results today are achieved with negative pressure system. Despite widespread use, there is still a lot of confusion regarding the indications, the application of the technique and complications. Objective: The aim of our study was to explain the system with negative pressure and show our experience and results in the treatment of patients with it. Methods: We retrospectively analyzed the data of all patients from 2011 to 2014 which were treated with negative pressure. We were interested in following data: the date of the primary surgery, diagnosis, date and indication for use of the system with negative pressure, the number of system changes, type of final closure of the abdominal cavity and the date of discharge or death. Results: Between 2011 and 2014 we treated 52 patients, 32 men and 20 women with a system with negative pressure. The average age of the patients was 67 years (25 - 85 years). 25 patients were operated on electively and due to complications we used the system for negative pressure. In 27 patients we used negative pressure system after the primary emergency procedure. Mortality was 50 %. Conclusion: The treatment of the open abdomen with negative pressure is an essential part of modern abdominal surgery. Survival after treatment with negative pressure is better than with other techniques of temporary abdominal closure. Man must take in consideration problems with fascial closure and big postoperative hernias wich demand further operations.

scholarly journals Overview on Temporary Abdominal Closure Techniques: A Review

2021 ◽  
pp. 68-74
Author(s):  
Hashem Bark Awadh Abood ◽  
Sadeel Fahad Daghistani ◽  
Nouf Hashem Koshak ◽  
Yazid Ali Alghamdi ◽  
Sahad sami Ghamri ◽  
...  
Keyword(s):  
Open Abdomen ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Advantages And Disadvantages ◽  
Abdominal Closure ◽  
Abdominal Hypertension ◽  
Fluid Regulation ◽  
Abdominal Compartment ◽  
Emergency Abdominal Surgery ◽  
The Ideal

Open abdomen (OA) is becoming more common, primarily to prevent intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) following emergency abdominal surgery. The purpose of temporary abdominal closure (TAC) techniques is no longer just abdomen coverage; fluid regulation and early fascial closure are now important considerations. TAC techniques for leaving the abdomen open are numerous. The ideal one should be simple to apply and remove, allow for quick access to a surgical second opinion, drain secretions, ease primary closure with acceptable morbidity and mortality, allow for easy nursing, and, finally, be readily available and inexpensive. Over the years, several TAC methods have been proposed. In this review, we overview different techniques for temporary abdominal closure and its advantages and disadvantages.

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.

scholarly journals Effect of Negative Pressure Therapy on Open Abdomen Treatments. Prospective Randomized Study With Two Commercial Negative Pressure Systems

2021 ◽  
Vol 7 ◽  
Author(s):  
Thomas Auer ◽  
Siegfried Sauseng ◽  
Pavle Delcev ◽  
Peter Kohek
Keyword(s):  
Negative Pressure ◽  
Randomized Study ◽  
Secondary Peritonitis ◽  
Repeated Measure ◽  
Fascial Closure ◽  
Fistula Formation ◽  
Intestinal Damage ◽  
Closure Rate ◽  
Pressure Therapy ◽  
Significant Difference

Introduction: The use of negative pressure dressings for open abdominal therapy has made a great impact on strategies for open abdominal treatment. Observed intestinal damage and developement of fistula formation raises questions about safety of commonly used systems (AB-Thera). The most common used system uses foils for shielding intestines directly from negative pressure. As an alternative a system with open pore dressing in double layer film was introduced (Suprasorb CNP) and proved to safe in animal studies. We compared the effects of this two systems on patients requiring open abdominal treatment.Materials and methods: Patients with secondary peritonitis in at least two abdominal quadrants were included in this randomized study. Inclusion criteria were secondary peritonitis (ACS), abdominal compartment syndrome, and abdominal trauma combined with ACS and/or contaminated abdomen. Patients with active bleeding and pancreatitis were not included. We examined Mannheim peritonitis Index (MPI), bloodcount, PCT, amount of fluid collected, and morphological changes on the bowel. Data were collected on day 2, 4, 7, 14, 21, and 28. Primary end point was fascial closure. Examination was terminated in case of death and damage to the abdominal organs. Groups were compared using Mann Whitney U-test and chi square test. Trend evaluation was evaluated using an one way repeated measure analysis of variance. P-values below 0.05 was considered significat.Results: Thirty four patients were included between August 2010 and September 2012. There were no significant difference between two groups in MPI, age, and gender. Mean duration of treatment, WBC, CRP, and abdominal closure rate were not significantly different between groups. Suprasorb CNP System collected twice more fluid than AB-Thera and decreased PCT on significantly faster rate than AB-Thera. Four patients died (11%) and four patients developed enteric fistula (11%). Closure rate was achieved in 27 out of 34 Patients (79.5%). Closure rate was not significantly different between groups.Conclusion: The use of both systems proved to be efficient and safe. The application of well-dosed, moderate negative pressure on contaminated areas of the abdomen seems to have a lot of potential and it is worth directing greater research potential in this direction.

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