Optimization of treatment for diffuse secondary peritonitis using vacuum-assisted abdominal closure technologies

Introduction. Diffuse secondary peritonitis remains a critical surgical challenge due to high mortality (30–60 % in sepsis) and limitations of traditional relaparotomies. Objective: To improve clinical outcomes in secondary peritonitis using vacuum-assisted abdominal closure technologies. Materials and methods of research. Included 283 patients with peritonitis (MPI≥20), divided into three groups: planned relaparotomies with passive drainage (group 1, n=145), vacuum-assisted laparostomy (VAL) with 48-hour sanitations (subgroup 2,1, n=81), and vacuum-instillation laparostomy (VIL) with 2,5 % glucose solution (group 3, n=57). Groups were comparable in sex, age, abdominal cavity index, Mannheim Peritonitis Index, and APACHE II score. Outcomes included mortality, Comprehensive Complication Index (CCI), surgical site infections, treatment duration, number of operations, and fascial closure in patients with completed sanitations. Treatment results. Group 1 had a mortality rate of 35,2 %, CCI of 66,8±34,2, and fascial closure of 73,0 %. Subgroup 2.1 showed reduced mortality (22.2 %, p=0,047), CCI (52,3±30,8, p=0,0013), and fascial closure of 89,6 %. Group 3 achieved the best results: mortality 19,3 % (p=0,018), CCI 44,43±31,4 (p<0,001), and fascial closure 92,2 %. VIL was optimal for severe peritonitis (MPI≥30, mortality 19,6 %, p=0,008). Conclusion. VAL and VIL outperform relaparotomies, reducing mortality and complications. VIL is optimal for severe peritonitis. The technologies have been implemented.