nach oben

European Journal of Trauma and Emergency Surgery

Erschienen in:

06.05.2020 | Original Article

Open abdomen closure methods for severe abdominal sepsis: a retrospective cohort study

verfasst von: Gaetano Poillucci, Mauro Podda, Giulia Russo, Sergio Gaetano Perri, Domenico Ipri, Gabriele Manetti, Maria Giulia Lolli, Renato De Angelis

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 6/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The open abdomen (OA) procedure as part of damage control surgery represents a significant surgical advance in severe intra-abdominal infections. Major techniques used for OA are negative pressure wound therapy (NPWT) and non-NPWT. The aim of this retrospective study is to evaluate the effects of different abdominal closure methods and their outcomes in patients presenting with abdominal sepsis treated with OA.

Materials and methods

We retrospectively analyzed clinical outcomes of patients affected by severe intra-abdominal sepsis treated with OA. Demographic features, mortality prediction score, abdominal closure methods, length of hospital stay, complications and mortality rates of patients were determined and compared.

Results

This study included 106 patients, of whom 77 underwent OA with NPWT and 29 with non-NPWT. OA duration was longer in NPWT patients (p = 0.007). In-hospital mortality rates in NPWT and in non-NPWT patients were 40.3% and 51.7%, respectively (p = 0.126), with an overall 30-day mortality rate of 18.2% and 51.7%, respectively (p = 0.0002). After emergency colorectal surgery, patients who underwent OA with NPWT had a lower rate of colostomy (p = 0.025).

Conclusions

NPWT is the best temporary abdominal closure technique to decrease mortality and colostomy rates in patients managed with OA for severe intra-abdominal infections.

Vincent JL, Sakr Y, Sprung CL, et al. Sepsis occurrence in acutely Ill patients investigators. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006;34(2):344–53.CrossRefPubMed

Brun-Buisson C, Doyon F, Carlet J, et al. Incidence, risk factors, and outcome of severe sepsis and septic shock in adults: a multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. JAMA. 1995;274(12):968–74.CrossRefPubMed

Schein M, Saadia R, Decker GG. The open management of the septic abdomen. Surg Gynecol Obstet. 1986;163(6):587–92.PubMed

Pieracci FM, Barie PS. Management of severe sepsis of abdominal origin. Scand J Surg. 2007;96(3):184–96.CrossRefPubMed

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;10:35. https://doi.org/10.1186/s13017-015-0032-7(eCollection 2015).CrossRefPubMedPubMedCentral

Coccolini F, Roberts D, Ansaloni L, et al. The open abdomen in trauma and non-trauma patients: WSES guidelines. World J Emerg Surg. 2018;13:7. https://doi.org/10.1186/s13017-018-0167-4(eCollection 2018).CrossRefPubMedPubMedCentral

Shapiro MB, Jenkins DH, Schwab CW, Rotondo MF. Damage control: collective review. J Trauma. 2000;49(5):969–78.CrossRefPubMed

Open Abdomen Advisory Panel, Campbell A, Chang M, et al. Management of the open abdomen: from initial operation to definitive closure. Am Surg. 2009;75(11 Suppl):S1–22.

Ogilvie WH. The late complications of abdominal war wounds. Lancet. 1940;2:253–6.CrossRef

10.

Sugrue M. Abdominal compartment syndrome and the open abdomen: any unresolved issues? Curr Opin Crit Care. 2017;23(1):73–8. https://doi.org/10.1097/MCC.0000000000000371.CrossRefPubMed

11.

Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801–10. https://doi.org/10.1001/jama.2016.0287.CrossRefPubMedPubMedCentral

12.

Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818–29.CrossRefPubMed

13.

Sartelli M, Catena F, Ansaloni L, et al. Complicated intra-abdominal infections worldwide: the definitive data of the CIAOW Study. World J Emerg Surg. 2014;9:37. https://doi.org/10.1186/1749-7922-9-37(eCollection 2014).CrossRefPubMedPubMedCentral

14.

Sartelli M. A focus on intra-abdominal infections. World J Emerg Surg. 2010;19(5):9. https://doi.org/10.1186/1749-7922-5-9.CrossRef

15.

Kiewiet JJ, van Ruler O, Boermeester MA, Reitsma JB. A decision rule to aid selection of patients with abdominal sepsis requiring a relaparotomy. BMC Surg. 2013;19(13):28. https://doi.org/10.1186/1471-2482-13-28.CrossRef

16.

Pommerening MJ, DuBose JJ, Zielinski MD, et al. Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy. Surgery. 2014;156(2):431–8. https://doi.org/10.1016/j.surg.2014.04.019.CrossRefPubMed

17.

Cristaudo AT, Jennings SB, Hitos K, Gunnarsson R, DeCosta A. Treatments and other prognostic factors in the management of the open abdomen: a systematic review. J Trauma Acute Care Surg. 2017;82(2):407–18. https://doi.org/10.1097/TA.0000000000001314.CrossRefPubMed

18.

Coccolini F, Montori G, Ceresoli M, et al. The role of open abdomen in non-trauma patient: WSES Consensus Paper. World J Emerg Surg. 2017;14(12):39. https://doi.org/10.1186/s13017-017-0146-1(eCollection 2017).CrossRef

19.

Coccolini F, Montori G, Ceresoli M, et al. IROA: international register of open abdomen, preliminary results. World J Emerg Surg. 2017;21(12):10. https://doi.org/10.1186/s13017-017-0123-8(eCollection 2017).CrossRef

20.

Atema JJ, Gans SL, Boermeester MA. Systematic review and meta-analysis of the open abdomen and temporary abdominal closure techniques in non-trauma patients. World J Surg. 2015;39(4):912–25. https://doi.org/10.1007/s00268-014-2883-6.CrossRefPubMed

21.

Bosscha K, Hulstaert PF, Visser MR, van Vroonhoven TJ, van der Werken C. Open management of the abdomen and planned reoperations in severe bacterial peritonitis. Eur J Surg. 2000;166(1):44–9.CrossRefPubMed

22.

Jamshidi R, Schecter WP. Biological dressings for the management of enteric fistulas in the open abdomen: a preliminary report. Arch Surg. 2007;142(8):793–6.CrossRefPubMed

23.

Kirkpatrick AW, Brenneman FD, McLean RF, Rapanos T, Boulanger BR. Is clinical examination an accurate indicator of raised intra-abdominal pressure in critically injured patients? Can J Surg. 2000;43(3):207–11.PubMedPubMedCentral

24.

Cheatham ML, Malbrain ML, Kirkpatrick A, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. II. recommendations. Intensive Care Med. 2007;33(6):951–62.CrossRefPubMed

25.

Bailey J, Shapiro MJ. Abdominal compartment syndrome. Crit Care. 2000;4(1):23–9.CrossRefPubMedPubMedCentral

26.

Goussous N, Kim BD, Jenkins DH, Zielinski MD. Factors affecting primary fascial closure of the open abdomen in the nontrauma patient. Surgery. 2012;152(4):777–83. https://doi.org/10.1016/j.surg.2012.07.015(Discussion 783–4).CrossRefPubMed

27.

Majercik S, Kinikini M, White T. Enteroatmospheric fistula: from soup to nuts. Nutr Clin Pract. 2012;27(4):507–12. https://doi.org/10.1177/0884533612444541.CrossRefPubMed

28.

Falconi M, Pederzoli P. The relevance of gastrointestinal fistulae in clinical practice: a review. Gut. 2001;49(Suppl 4):2–10.

29.

Hahler B, Schassberger D, Novakovic R, Lang S. Managing complex, high-output, enterocutaneous fistulas: a case study. Ostomy Wound Manage. 2009;55(10):30–42.PubMed

30.

Bruhin A, Ferreira F, Chariker M, Smith J, Runkel N. Systematic review and evidence-based recommendations for the use of negative pressure wound therapy in the open abdomen. Int J Surg. 2014;12(10):1105–14. https://doi.org/10.1016/j.ijsu.2014.08.396.CrossRefPubMed

31.

Navsaria PH, Bunting M, Omoshoro-Jones J, Nicol AJ, Kahn D. Temporary closure of open abdominal wounds by the modified sandwich-vacuum pack technique. Br J Surg. 2003;90(6):718–22.CrossRefPubMed

32.

Miller PR, Meredith JW, Johnson JC, Chang MC. Prospective evaluation of vacuum-assisted fascial closure after open abdomen: planned ventral hernia rate is substantially reduced. Ann Surg. 2004;239(5):608–14 (Discussion 614–6).CrossRefPubMedPubMedCentral

33.

Van Ruler O, Lamme B, De Vos R, et al. Decision-making for relaparotomy in secondary peritonitis. Dig Surg. 2008;25(5):339–46. https://doi.org/10.1159/000158911.CrossRefPubMed

34.

Ordóñez CA, Sánchez AI, Pineda JA, et al. Deferred primary anastomosis versus diversion in patients with severe secondary peritonitis managed with staged laparotomies. World J Surg. 2010;34(1):169–76. https://doi.org/10.1007/s00268-009-0285-y.CrossRefPubMedPubMedCentral

35.

Kafka-Ritsch R, Birkfellner F, Perathoner A, et al. Damage control surgery with abdominal vacuum and delayed bowel reconstruction in patients with perforated diverticulitis Hinchey III/IV. J Gastroenterol Surg. 2012;16:1915–22.CrossRef

Titel: Open abdomen closure methods for severe abdominal sepsis: a retrospective cohort study
verfasst von: Gaetano Poillucci
Mauro Podda
Giulia Russo
Sergio Gaetano Perri
Domenico Ipri
Gabriele Manetti
Maria Giulia Lolli
Renato De Angelis
Publikationsdatum: 06.05.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Trauma and Emergency Surgery / Ausgabe 6/2021
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-020-01379-0

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose

Materials and methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 6/2021

Osteosynthesis of proximal humeral fractures: a 1-year analysis of failure in a Belgian level-1 trauma centre

Expression of Notch and Wnt/β-catenin signaling pathway in acute phase severe brain injury rats and the effect of exogenous thyroxine on those pathways

Inferior vena cava filters reduce symptomatic but not fatal pulmonary emboli after major trauma: a meta-analysis with trial sequential analysis

Questioning dogma: does a GCS of 8 require intubation?

Risk factors for postoperative morbidity following appendectomy in the elderly: a nationwide prospective cohort study