Vacuum-assisted laparostomy for diffuse postoperative peritonitis in patients with abdominal cancers

Uvarov I.B.; Manuilov A.M.; Sichinava D.D.

doi:https://doi.org/10.17116/hirurgia202504153

OBJECTIVE

To improve the outcomes in patients with abdominal cancers complicated by diffuse postoperative peritonitis (DPP) using vacuum-assisted laparostomy (VAL) with elective staged peritoneal lavage.

MATERIAL AND METHODS

There were 141 patients with DPP: group I (63 patients) — VAL, group II (78 patients) — redo laparotomy on demand (RD). Negative pressure therapy was performed using commercial vacuum systems with vacuum dressing changes after 48 — 72 hours. We assessed mortality, morbidity, abdominal cavity status (Björck classification) and incidence of primary fascial closure of abdominal cavity.

RESULTS

There were 10 (15.9%) and 24 (30.8%) deaths, respectively (p=0.040). Complications Clavien—Dindo grade 3—5 were significantly more common in the 2^nd group. According to the Björck classification, grades 2A (39.7%) and 2B (41.3%) became more common after the 2^nd peritoneal lavage in the 1^st group. After the 3^rd and further staged peritoneal lavages, «frozen open abdomen» (grade 3A and 4) prevailed. This classification revealed significant correlations with abdominal index, intra-abdominal hypertension and C-reactive protein. Primary fascial closure of abdominal cavity was performed in 40 (63.5%) patients in the 1^st group.

CONCLUSION

Vacuum-assisted laparostomy is effective for diffuse postoperative peritonitis compared to on-demand relaparotomy. This approach provides lower mortality and morbidity rates, as well as better control over local inflammatory process and intra-abdominal pressure.

Keywords:

postoperative peritonitis

negative pressure therapy

vacuum therapy

relaparotomy on demand

laparostomy

Authors:

Uvarov I.B.

Kuban State Medical University;
Regional Oncological Center No. 1

ORCID: 0000-0002-2725-3281

Manuilov A.M.

Kuban State Medical University

ORCID: 0000-0002-5928-6520

Sichinava D.D.

Regional Oncological Center No. 1

ORCID: 0000-0001-8630-036X

Received:

28.07.2024

Accepted:

14.08.2024

Close metadata

References:

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