"Open abdomen" in the treatment of secondary peritonitis and abdominal sepsis: limiting factors

Introduction. Despite the lack of studies with a high level of evidence regarding the effectiveness of VAC-laparostomy in severe forms of secondary peritonitis, significant experience in the application of this surgical strategy has been accumulated in practical surgery, and the accumulated results make it possible to analyze possible contraindications and risk factors for the use of this technique. The purpose of the study. To detail contraindications to vacuum-assisted laparotomy in the surgical treatment of secondary peritonitis complicated by abdominal sepsis. Materials and methods of research. The results of treatment of 84 patients with abdominal sepsis treated with vacuum-assisted laparostomy (VALS) were analyzed. In all patients, abdominal sepsis was the result of secondary peritonitis, the source of which was defects in various parts of the gastrointestinal tract (GIT). Most patients (85,7 %) were diagnosed with septic shock at the time of initial surgery, and many patients (81 %) underwent surgery later than 24 hours after the onset of the disease. The correlation of treatment results what depending on the initial localization of the source of peritonitis. Treatment results. The overall mortality rate in the study was 38 %. In the group of patients with localization of the source of peritonitis in the small intestine, mortality was 52,8 %. In the group of patients with the source of peritonitis in other parts of the gastrointestinal tract, mortality was 27 %. The difference in mortality in the groups was significant (p<0,05). The success rate of primary fascial closure (PFC) was also significantly different in the groups (31,3 % vs. 82,5 %, p<0,05). Conclusion. There is reason to believe that in the presence of sutured areas or areas of damage to the serous membrane of the small intestine in secondary peritonitis, it is necessary either to completely abandon the use of VALS, or to use reduced versions of vacuum dressings, which provide for the effect of negative pressure only within the laparotomy wound with isolation of the negative pressure zone from the free abdominal cavity with synthetic prostheses fixed to the fascial edges of the wound.