Indication and Role of Laparostomy in Management of Patients with Acute Intra-abdominal Sepsis and Trauma

Abstract

Abstract Introduction: Laparostomy is a surgical treatment method, in which the peritoneal cavity is entered and deliberately left un-sutured, hence often called ‘open abdomen’. The abdominal contents are exposed and protected with temporary coverage. It is mainly done to avoid abdominal compartment syndrome (ACS). Aim: This study aimed to identify the indications and analyse the outcome of laparostomy in patients with acute intra-abdominal sepsis and trauma. Materials and Methods: This prospective study was conducted on laparostomy cases over a period of 14 months. Data were analysed for the indication, clinical course and outcome. Results were expressed as frequency percentage, means, procedural morbidity and overall mortality. Results: A total of 17 laparostomies were performed during the study period. Massive intra-abdominal sepsis with ACS was the most common indication followed by gangrenous intestine requiring re-looks. Mortality observed was 17%. The common complications noted were spontaneous enterocutaneous fistula in 33% of patients. Seventeen per cent of patients underwent redo surgeries. Primary closure was possible only in 11 patients. Conclusion: Laparostomy is a valuable emergency damage control measure in desperate situations of severe abdominal sepsis or trauma where it can prevent ACS which is life-threatening, despite its association with high morbidity and, consequently, long hospital stay.