Laparostomy for combat abdominal trauma. criteria for the possibility and optimal timing of laparostomy closure

Introduction. The article is devoted to the analysis of the use of laparostomy in patients with combat abdominal trauma (BAT) and the definition of criteria, timing and methods of its closure. A multifactorial retrospective analysis of the data of 304 patients with laparostomy formed at the stages of medical evacuation revealed that the timing and method of laparostomy closure depend on the initial severity of the injury, the effectiveness of programmatic sanitation and the choice of technology for temporary closure of the abdominal cavity. Materials and methods. A retrospective multifactorial analysis of the primary medical documentation of a sample of 304 patients hospitalized at the Vishnevsky National Research Medical Center of the Ministry of Defense of the Russian Federation in the period 2022–2024 inclusive with laparostoma formed during surgery for BAT at the stages of medical evacuation was carried out. The results of the study. When comparing the average severity of the condition of patients in clinical groups 1 and 2 at the time of hospitalization from the stages of medical evacuation to the Vishnevsky National Research Medical Center of the Ministry of Defense of the Russian Federation, significant differences (p < 0,05) in these indicators were revealed for all scales used in the study. The optimal period for primary fascial closure of laparostomy is the period 7–8 days after the initial operation. Control of the source of infection and adequate systemic antibacterial therapy make it possible to complete the open management program by closing the laparostome. Laparostomy closure at a later date is associated with an increased risk of intra-abdominal and wound complications. Primary fascial closure of the laparostome cannot be performed in the presence of intestinal fistula, massive adhesions (Bjork - 2b), extensive abdominal wall defect, intraabdominal hypertension; under these circumstances, laparostome closure is performed by applying skin sutures. Discussion. The formation of a laparostomy with subsequent abdominal rehabilitation at the stages of medical evacuation is currently a common treatment strategy for patients with BAT. The transformation of criteria for the possibility of completing the program of stage-by-stage rehabilitation and primary fascial closure of laparostomy into surgical tactics algorithms for BAT is the subject of further research. Conclusion. The conducted study illustrates the fact that the timing and technology of completing the program of staged rehabilitation for laparostomy depend on the initial severity of BAT, the adequacy of intra-abdominal infection control, and the choice of a method for temporary closure of the abdominal cavity.