Open abdomen as a method of source control in peritonitis: indications and risks

Lebedev N.V.; Klimov A.E.; Parshin D.S.; Jaghnoun K.M.; Synkova M.D.; Abuladze I.O.

doi:https://doi.org/10.17116/hirurgia202606115

Lebedev N.V.

Patrice Lumumba Peoples’ Friendship University of Russia, Moscow, Russia

ORCID: 0000-0002-7745-1390

Klimov A.E.

Patrice Lumumba Peoples’ Friendship University of Russia, Moscow, Russia

ORCID: 0000-0002-0001-8003

Parshin D.S.

Astrakhan State Medical University, Astrakhan, Russia

ORCID: 0000-0002-1050-7716

Jaghnoun K.M.

Patrice Lumumba Peoples’ Friendship University of Russia, Moscow, Russia

ORCID: 0009-0004-4236-2357

Synkova M.D.

Patrice Lumumba Peoples’ Friendship University of Russia, Moscow, Russia

ORCID: 0009-0006-0436-4938

Abuladze I.O.

Patrice Lumumba Peoples’ Friendship University of Russia, Moscow, Russia

ORCID: 0000-0002-3576-4815

Open abdomen as a method of source control in peritonitis: indications and risks

Authors:

Lebedev N.V., Klimov A.E., Parshin D.S., Jaghnoun K.M., Synkova M.D., Abuladze I.O.

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Journal: Pirogov Russian Journal of Surgery. 2026;(6): 15‑21

DOI: 10.17116/hirurgia202606115

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To cite this article:

Lebedev NV, Klimov AE, Parshin DS, Jaghnoun KM, Synkova MD, Abuladze IO. Open abdomen as a method of source control in peritonitis: indications and risks. Pirogov Russian Journal of Surgery. 2026;(6):15‑21. (In Russ.)
https://doi.org/10.17116/hirurgia202606115

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

Использование инфографики авторами научных работ

OBJECTIVE

To compare the results of staged surgical treatment of patients with disseminated secondary peritonitis and to clarify the indications for open abdomen technique.

MATERIAL AND METHODS

We analyzed treatment outcomes in 978 patients with disseminated peritonitis. The main causes of peritonitis were destructive appendicitis (430 patients, 43.9%) and gastroduodenal ulcer perforation (217 patients, 22.2%).

RESULTS

Staged debridement in patients with high risk of death (WSES SSS score ≥ 9) significantly reduces in mortality in this group of patients (from 82.5% with traditional tactics to 62.1%). Staged debridement in patients with lower probability of death (WSES SSS score 7–8) does not significantly affect the outcomes. Open abdomen method significantly reduces mortality in patients with abdominal sepsis and septic shock compared to primary suturing and elective re-laparotomy from 75% to 35.3%. Open abdomen method in patients with intra-abdominal pressure >20 mmHg is associated with significantly lower mortality compared to primary suturing (traditional technique) and elective re-laparotomy. VAC systems significantly reduce mortality in patients with WSES SSS score ≥7 compared to anterior abdominal wall closure with local tissues during elective re-laparotomy. The benefit of VAC systems for milder manifestations of peritonitis is not significant.

CONCLUSION

Indications for open abdomen technique include intraabdominal pressure >20 mmHg or abdominal compartment syndrome. This method prevents tissue ischemia, formation of purulent pockets and, consequently, progression of peritonitis in postoperative period. Open abdomen technique is advisable if hemodynamic instability makes surgery impossible.

Keywords:

peritonitis

open abdomen

surgical tactics

infection source control

Authors:

Lebedev N.V.

Patrice Lumumba Peoples’ Friendship University of Russia, Moscow, Russia

ORCID: 0000-0002-7745-1390

Klimov A.E.

Patrice Lumumba Peoples’ Friendship University of Russia, Moscow, Russia

ORCID: 0000-0002-0001-8003

Parshin D.S.

Astrakhan State Medical University, Astrakhan, Russia

ORCID: 0000-0002-1050-7716

Jaghnoun K.M.

Patrice Lumumba Peoples’ Friendship University of Russia, Moscow, Russia

ORCID: 0009-0004-4236-2357

Synkova M.D.

Patrice Lumumba Peoples’ Friendship University of Russia, Moscow, Russia

ORCID: 0009-0006-0436-4938

Abuladze I.O.

Patrice Lumumba Peoples’ Friendship University of Russia, Moscow, Russia

ORCID: 0000-0002-3576-4815

Received:

20.05.2025

Accepted:

13.06.2025

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References:

Maskin SS, Aleksandrov VV, Derbentseva TV, Matyukhin VV, Rashid A, Sigaev SM, Biriulev DS. Prerequisites for using the results of a systematic review and meta-analysis in real clinical practice: comparison of vacuum-assisted laparostomy with other options for staged surgical treatment of urgent abdominal pathology and abdominal trauma. Vestnik Volgogradskogo meditsinskogo universiteta. 2024;21(2):3-12. (In Russ.). https://doi.org/10.19163/1994-9480-2024-21-2-3-11
Hecker A, Reichert M, Reuß CJ, Schmoch T, Riedel JG, Schneck E, Padberg W, Weigand MA, Hecker M. Intraoperative vacuum therapy for the treatment of peritonitis: a prospective multicenter study. Langenbeck’s Arch Surg. 2019;404:257-271. https://doi.org/10.1007/s00423-019-01752-7
Kirkpatrick AW, Delis S, Coccolini F, Tolonen TM. Re-laparotomies in patients with intra-abdominal infections: when and how. In: Sartelli M, Coccolini F, Catena F, Pagani L, eds. Global Infection Prevention and Management in Healthcare. 1st edn. Milan: Global Alliance for Infections in Surgery; 2024:412-421.
Ivanov FB, Kotiv BN, Dzidzava II, Barinov OV, Gumilevskii BYu. Effectiveness of “on-demand” relaparotomy in widespread peritonitis. International Research Journal. 2023;12(138):193. (In Russ.). https://doi.org/10.23670/IRJ.2023.138.86
Rajabaleyan P, Michelsen J, Tange U, Möller S, Toft P, Luxhøi J, Buyukuslu M, Bohm AM, Borly L, Sandblom G, Kobborg M, Poulsen KA, Løve US, Ovesen S, Sølling CG, Søndergaard BM, Lomholt ML, Møller DR, Qvist N, Ellebæk MB. Vacuum-assisted closure versus on-demand relaparotomy in patients with secondary peritonitis — the VACOR trial: protocol for a randomised controlled trial. World J Emerg Surg. 2022;17:25. https://doi.org/10.1186/s13017-022-00427-x
van Ruler O, Boermeester MA. Surgical treatment of secondary peritonitis: a continuing problem. Chirurg. 2017;88(1):1-6. https://doi.org/10.1007/s00104-015-0121-x
Lebedev NV, Klimov AE, Persov MB. Peritonitis and abdominal sepsis. Moscow: GEOTAR-Media; 2023. (In Russ.). https://doi.org/10.33029/9704-8069-4-PAS-2023-1-164
Sazhin AV, Ivakhov GB, Teplykh AV, Kalinina AA. Vacuum-assisted laparostomy in the complex treatment of widespread peritonitis: a literature review. Moskovskij khirurgicheskij zhurnal. 2020;4(74):65-74. (In Russ.).
Sigua BV, Zemlyanoy VP, Petrov SV, Ignatenko VA, Kotkov PA. Surgical aspects of the treatment of patients with generalized peritonitis. Russian Sklifosovsky Journal of Emergency Medical Care. 2021;10(1):58-65. (In Russ.). https://doi.org/10.23934/2223-9022-2021-10-1-58-65
Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):762-774. https://doi.org/10.1001/jama.2016.0288
Cassini A, Fleischmann-Struzek C, Naghavi M, Reinhart K, Allegranzi B; WHO Sepsis Epidemiology Task Force Group. Future directions and priorities in sepsis epidemiology research: a call for action. Bull World Health Organization. 2021;99(5):398-401. https://doi.org/10.2471/BLT.20.276709
Linder MM, Wacha H, Feldmann U, Wesch G, Streifensand RA, Gundlach E. The Mannheim peritonitis index: an instrument for the intraoperative prognosis of peritonitis. Chirurg. 1987;58(2):84-92.
Lebedev NV, Klimov AE, Shadrina VS, Belyakov AP. Choice of surgical approach and option for completing laparotomy in widespread peritonitis. Pirogov Russian Journal of Surgery = Khirurgiya. Zhurnal im. N.I. Pirogova. 2023;10:41-46. (In Russ.). https://doi.org/10.17116/hirurgia202310141
Sartelli M, Abu-Zidan FM, Catena F, Griffiths EA, Di Saverio S, Coimbra R, Ordoñez CA, Leppaniemi A, Fraga GP, Coccolini F, et al. Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study). World J Emerg Surg. 2015;10:61. https://doi.org/10.1186/s13017-015-0055-0
Sartelli M, Tascini C, Coccolini F, Dellai F, Ansaloni L, Antonelli M, et al. Management of intra-abdominal infections: recommendations by the Italian council for the optimization of antimicrobial use. World J Emerg Surg. 2024;19:23. https://doi.org/10.1186/s13017-024-00551-w
Ordoñez CA, Caicedo Y. Damage control surgery in managing severe intra-abdominal infections. In: Sartelli M, Coccolini F, Catena F, Pagani L, eds. Global Infection Prevention and Management in Healthcare. 1st edn. Milan: Global Alliance for Infections in Surgery; 2024.
Coccolini F, Sartelli M, Sawyer R, Rasa K, Viaggi B, Abu-Zidan F. Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines. World J Emerg Surg. 2023;18:41. https://doi.org/10.1186/s13017-023-00509-4
Parshin DS, Topchiev MA, Astakhin VA, Chechukhina OB, Smirnyagina EO, Ravskiy EN. Surgical site infections: risk factors for multiple antibiotic resistance in abdominal surgery. Russian Sklifosovsky Journal of Emergency Medical Care. 2024;13(3):410-418. (In Russ.). https://doi.org/10.23934/2223-9022-2024-13-3-410-418
Martínez ML, Ferrer R, Torrents E, Guillamat-Prats R, Gomà G, Suárez D, et al. Impact of source control in patients with severe sepsis and septic shock. Crit Care Med. 2017;45(1):11-19. https://doi.org/10.1097/CCM.0000000000002011