Initial Experience of Laparostomy with Immediate Vacuum Therapy in Patients with Severe Peritonitis

Abstract

INTRODUCTION To report our initial experience of laparostomy and immediate intra-abdominal vacuum therapy in patients with severe peritonitis due to intra-abdominal catastrophes. PATIENTS AND METHODS Twenty-seven patients underwent emergency laparotomy and laparostomy formation with the application of immediate intra-abdominal TRAC-VAC ® therapy (male:female ratio, 1:1.2; median age, 73 years; range, 34-84 years). Predicted mortality was assessed using the P-POSSUM score and compared with clinically observed outcomes. RESULTS Ten patients (37%) with a mean predicted P-POSSUM mortality of 72%, died of sepsis and multi-organ failure. Seventeen patients (mean P-POSSUM 48% expected mortality) survived to discharge. One patient with pancreatitis died from small bowel obstruction 1-year post discharge, two patients developed a small bowel fistula. One patient had an allergic reaction to the VAC dressing. Our patients, treated with laparostomy and TRAC VAC therapy, had a significantly improved observed survival when compared to P-POSSUM expected survival (P = 0.004). CONCLUSIONS Laparostomy with immediate intraperitoneal VAC therapy is a robust and effective system to manage patients with intra-abdominal catastrophes. There were significantly improved outcomes compared to the mortality predicted by P-POSSUM scores. Damage control surgery with laparostomy formation and intra-abdominal VAC therapy should be considered in patients with severe peritonitis.

The Effect of Vacuum-Assisted Closure in Bacterial Clearance of the Infected Abdomen

“…The decision to continue management with an open abdomen is made at the time of each re-operation after an initial laparostomy and is based on the need for a new, planned re- [5,9,13]. Although VAC has proven its efficacy in improving survival in several studies [9,13], it is not clear how the negative pressure it creates contributes to the treatment of these patients. Many authors have implied a role of negative pressure in removing the microbial burden on the infected abdomen [8,12,13].…”

“…Although VAC has proven its efficacy in improving survival in several studies [9,13], it is not clear how the negative pressure it creates contributes to the treatment of these patients. Many authors have implied a role of negative pressure in removing the microbial burden on the infected abdomen [8,12,13]. However, there is no evidence that VAC has such an effect.…”

“…Although evidence-based data are missing, topical negative pressure in patients with severe abdominal infection appears to make a positive contribution to the treatment of these critically ill patients [12,13]. An important issue to be addressed is whether negative abdominal pressure alters the composition of the bacterial population in the peritoneal cavity.…”

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

“…The level of vacuum can be altered individually, although the best results have been demonstrated with a pressure of 125 mmHg [2,10]. The recommended interval between dressing changes is usually 24 to 72 h; however, the actual timing of dressing changes may vary individually depending on the patient's clinical status and indications [1,2,10,24]. …”

Laparostomy closure in stage 4S neuroblastoma

“…This led us to consider vacuum therapy that aims to speed up epithelialization and reduce infective complications [6]. Vacuum therapy after laparostomy remains controversial in adults [15,16] and in children [4]. We consider that the vacuum drainage system was a useful method for managing fluid leakage resulting from mesh laparostomy even in the absence of infection and subjectively improved patient comfort, allowing a large wound to be managed in the community.…”