Affiliation:
1. Department of Surgery, Ospedale di Circolo ASST Settelaghi Varese, Italy
2. Department of Surgery ASST Valle Olona Gallarate, Italy
3. Division of Vascular Surgery IRCCS San Raffaele Scientific Institute Milan, Italy
4. Division for Endocrine and Minimally Invasive Surgery of the University of Messina, Italy
Abstract
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.
Publisher
Surgical Technology Online
Reference107 articles.
1. 1. Schein M, Rogers PN, Assalia A. Schein's Common Sense Emergency Abdominal Surgery: An Unconventional Book for Trainees and Thinking Surgeons. Berlin: Springer; 2010.
2. 2. Sartelli M, Abu-Zidan FM, Ansaloni L, et al. The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper. World J Emerg Surg 2015 Aug 12;10:35. doi: 10.1186/s13017-015-0032-7.
3. 3. Finlay IG, Edwards TJ, Lambert AW. Damage control laparotomy. Br J Surg 2004 Jan;91(1):83-5. doi:10.1002/bjs.4434
4. 4. Wild T, Staettner S, Lechner P, et al. Experience with Negative Pressure Therapy in Temporary Abdominal Closure of Patients with Secondary Peritonitis. NPWT 2014;1:33-8.
5. 5. Ogilvie WH. The late complications of abdominal war-wounds. Lancet 1940;2,253-6.
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