Abdominal negative-pressure therapy: a new method in countering abdominal compartment and peritonitis - prospective study and critical review of literature

Abstract

BackgroundApplication of abdominal negative-pressure therapy (NPT) is lifesaving when conservative measures fail to reduce sustained increase of the intra-abdominal pressure and it is impossible to achieve source control in a single operation due to severe peritonitis. The aim of this study is to share the initial experience with abdominal NPT in Latvia and provide a review of the relevant literature.MethodsIn total, 22 patients were included. All patients were treated with KCI® ABThera™ NPT systems. Acute Physiology and Chronic Health Evaluation II (APACHE II) score on admission, daily sequential organ failure assessment score and Mannheim peritonitis index (MPI) were calculated for severity definition. The frequency of NPT system changes, daily amount of aspirated fluid effluent and the time of abdominal closure were assessed. The overall hospital and ICU stay, as well as the outcomes and the complication rate, were analysed.ResultsA complicated intra-abdominal infection was treated in 18 patients. Abdominal compartment syndrome due to severe acute pancreatitis (SAP), secondary ileus and damage control in polytrauma were indications for NPT in four patients. The median age of the patients was 59 years (range, 28 to 81), median APACHE II score was 15 points (range, 9 to 32) and median MPI was 28 points (range, 21 to 40), indicating a prognostic mortality risk of 60%. Sepsis developed in all patients, and in 20 of them, it was severe. NPT systems were changed on a median of every 4 days, and abdominal closure was feasible on the seventh postoperative day without needing a repeated laparotomy. Two NPT systems were removed due to bleeding from the retroperitoneal space in patients with SAP. Intestinal fistulae developed in three patients that were successfully treated conservatively. Incisional hernia occurred in three patients. The overall ICU and hospital stay were 14 (range, 5 to 56) and 25 days (range, 10 to 87), respectively. Only one patient died, contributing to the overall mortality of 4.5%.ConclusionsApplication of abdominal NPT could be a very promising technique for the control of sustained intra-abdominal hypertension and management of severe sepsis due to purulent peritonitis. Further trials are justified for a detailed evaluation of abdominal NPT indications.

Acute kidney injury following acute pancreatitis: A review

“…83,89 ). Plaudis et al described abdominal negative-pressure therapy in their prospective study with 25 surgical patients as a new method in countering ACS and peritonitis 90 . However, management of the open abdomen is still associated with a number of complications including persistent sepsis and development of multiple organ dysfunction [91][92][93] .…”

Negative Pressure Wound Therapy in the Prevention of Infectious Wound Complications in Perineal Wound After Abdominoperineal Resection

“…В литературе имеются упоминания о при мене-нии ЛОД при самых различных патологиях: острой травме, ранах различного генеза, термических пора-жениях, остеомиелите, некротизирующем фасциите, пролежнях, гнойных ранах и трофических язвах, ди-абетической стопе, лимфостазе, перитоните, кишеч-ных свищах, абдоминальной травме, несостоятельно-сти кишечных анастомозов и абсцессах малого таза; в челюстно-лицевой, спинальной, торакальной, со-судистой, пластической и реконструктивной хирур-гии, в педиатрии [14,[18][19][20][21][22][23]. Использование специ-альных защитных покрытий, располагаемых между органами брюшной полости и пенополиуретановой губкой, на которую подается отрицательное давление, снижает риски развития таких осложнений, как ише-мия кишечника, кишечные свищи и кровотечения [24][25][26].…”

Application of negative pressure wound therapy in patients with wound dehiscence after abdominal open surgery: a single center experience

“…Whereas the application of NPWT to surgical abdominal wounds was initiated as a form of damage control surgery in trauma patients or for temporary wound closure prior to a second look operation in the 2000s [3,4]. Recently, NPWT has applied in patients who were diagnosed with abdominal compartment syndrome as an essential procedure of decompressive laparotomy [5,6]. The majority of previous studies on the topic have focused on effective closure of opened abdominal wounds using NPWT, and relatively few reports have been issued on the use of NPWT to treat postoperative wound complications.…”