Differentiated approach for using vacuum-assisted laparostomy in gunshot abdominal wounds

Abstract

The OBJECTIVE was to evaluate the results of using vacuum-assisted laparostomy in the surgical treatment of victims with gunshot abdominal wounds and clarify the indications for its use.METHODS AND MATERIALS. A comparative assessment of the results of surgical treatment of 180 victims with gunshot abdominal wounds was carried out. In the retrospective group (90 patients), vacuum-assisted laparostomy was used in accordance with the recommendations of the World Society of Emergency Surgery and national clinical guidelines for the treatment of peritonitis. To clarify the indications for vacuum-assisted laparostomy in patients of the prospective group (n=90), the risk scale for peritonitis progression in gunshot abdominal wounds (priority certificate № 2024100144) was used. The study groups were comparable according to the main clinical criteria: age of victims, severity of injuries, and structure of surgical interventions.RESULTS. In the retrospective group, vacuum-assisted laparostomy was performed in 41 % of cases, in the prospective group – in 56 % of victims. In-hospital mortality was 5.5 % and 2.3 %, respectively (p=0.2). The incidence of complications of grade III–IV according to Clavien–Dindo in the retrospective group was 34.5 %, and in the prospective group – 23.3 % (p = 0.07). At the same time, the progression of peritonitis with the development of abdominal sepsis was noted in 8 patients in the retrospective group and in 2 patients in the prospective group (14.2 % and 3.4 %, p = 0.04).CONCLUSION. Vacuum-assisted laparostomy is the important element of the surgical treatment program for victims with gunshot abdominal wounds, allowing implementation of damage control tactics and providing reliable control over the infectious process. The use of the developed risk scale for peritonitis progression substantiates the indications for vacuum-assisted laparostomy for gunshot abdominal wounds, which helps to reduce the incidence of abdominal sepsis.