Management of the open abdomen using negative pressure wound therapy with instillation in severe abdominal sepsis

Sibaja, Pablo; Sánchez, Alfredo García; Villegas, G.; Apéstegui, Alvaro; Mora, Esteban

doi:10.1016/j.ijscr.2016.11.024

Cited by 24 publications

(25 citation statements)

References 28 publications

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“…No data exist in the literature regarding EAF and intraperitoneal FI; some authors, however, agreed that FI has an indirect impact on EAF rate by reducing the OA time and improving the infection resolution [30,32]. The present study did not find significant differences in OA duration linked to FI versus NFI (9 vs. 11 days, respectively), and no statistically significant differences were found in the definitive closure of the abdomen, contrary to what was found in other studies [29,32]. A statistically significant advantage in fascial closure was furthermore identified in FI group, as shown by previous studies [29][30][31][32][33].…”

Section: Discussioncontrasting

confidence: 97%

Open Abdomen and Fluid Instillation in the Septic Abdomen: Results from the IROA Study

Coccolini¹,

Gubbiotti

Ceresoli

et al. 2020

World j. surg.

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Background Open abdomen (OA) is a surgical option that can be used in patients with severe peritonitis. Few evidences exist to recommend the use of intraperitoneal fluid instillation associated with OA in managing septic abdomen. Materials and methods A prospective analysis of adult patients enrolled in the International Register of Open Abdomen (trial registration: NCT02382770) was performed. Results A total of 387 patients were enrolled in two groups: 84 with peritoneal fluid instillation (FI) and 303 without (NFI). The groups were homogeneous for baseline characteristics. Overall complications were 92.9% in FI and 86.3% in NFI (p = 0.106). Complications during OA were 72.6% in FI and 59.9% in NFI (p = 0.034). Complications after definitive closure were 70.8% in FI and 61.1% in NFI (p = 0.133). Entero-atmospheric fistula was 13.1% in FI and 12% in NFI (p = 0.828). Fascial closure was 78.6% in FI and 63.7% in NFI (p = 0.02). Analysis of FI in negative pressure wound therapy (NPWT) showed: Overall morbidity in NPWT was 94% and in non-NPWT 91.2% (p = 0.622) and morbidity during OA was 68% and 79.4% (p = 0.25), respectively. Definitive fascial closure in NPWT was 87.8% and 96.8% in non-NPWT (p = 0.173). Overall mortality was 40% in NPWT and 29.4% in non-NPWT (p = 0.32) and morality during OA period was 18% and 8.8% (p = 0.238), respectively. Conclusion We found intraperitoneal fluid instillation during open abdomen in peritonitic patients to increase the complication rate during the open abdomen period, with no impact on mortality, entero-atmospheric fistula rate and opening time. Fascial closure rate is increased by instillation. Fluid instillation is feasible even when associated with nonnegative pressure temporary abdominal closure techniques.

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Section: Discussioncontrasting

confidence: 97%

Open Abdomen and Fluid Instillation in the Septic Abdomen: Results from the IROA Study

Coccolini¹,

Gubbiotti

Ceresoli

et al. 2020

World j. surg.

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“…In addition, V-HOCL was not hazardous to the peritoneum or serosal surfaces of the abdominal organs as a washout solution or irrigant with NPWT-i. This study confirmed the findings and recommendations of Fraser controlled fashion in trauma and general surgery patients using NPWT-i [16].…”

Section: Discussionsupporting

confidence: 89%

Hypochlorous Acid for Septic Abdominal Processes Using a Unique Negative Pressure Wound Therapy System: A Pilot Study

Matthews¹,

Quan²,

Shah³

et al. 2018

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Background: Septic open abdomens occur in trauma, burn and surgery. Currently, multiple concentrations of hypochlorous acid solutions have effectively decreased the microbiotic burden in wounds. We hypothesized that Vashe  , a neutral hypochlorous acid solution (V-HOCL), would be safe as an intraperitoneal irrigation or washout disinfectant for septic open abdomens utilizing negative pressure wound therapy. Methods: This is a retrospective observational review of patients who required delayed abdominal closures after exploratory laparotomies. Group A (n = 8) had cyclical V-HOCL irrigation to their open abdomens combining Abthera TM and V.A.C. Dressing System for negative pressure wound therapy with irrigation (NPWT-i) and Group B (n = 9) had intra-abdominal V-HOCL washouts. Results: Fifty percent of both groups had either septic or hemorrhagic shock on admission. Compared to Group B, Group A patients were older (median 50 vs 37 years), and had a median hospitalization of 28 vs 8 days, 4 times as many operations, more acute renal failure and co-morbidities. No statistically significant differences were detected between the two treatment methods with the V-HOCL delivery and removal. Conclusion: There were no episodes of electrolyte imbalance, hypotension, hypertension, anaphylaxis, hemorrhage, visceral injury or systemic toxicity. V-HOCL with/without NPWT-i irrigation was a safe modality and tolerated well in this study.

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“…Recently, there have been an increasing number of reports of OAM with NPWT for traumatic diseases, severe peritonitis, severe pancreatitis and ECF. [18] , [19] It is also thought that OAM with NPWT is useful for chronic cases which the timing of surgical intervention was delayed, such as the present case. In the future, the increased spread of indications of OAM for nontraumatic diseases may lead to favorable postoperative outcomes.…”

Section: Discussionmentioning

confidence: 75%

The successful management for long-term intractable enteroatmospheric fistula: A case report

Tatsuta

Oshima

Ishimatsu

et al. 2020

Annals of Medicine and Surgery

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Introduction Efficacy of open abdomen management with negative pressure wound therapy for enteroatmospheric fistula has been performed. But, few reports have shown its utility for enteroatmospheric fistula several years after onset. Presentation of case A 46 year-old woman underwent total colectomy due to total ulcerative colitis in her twenties. Three years before the onset of enteroatmospheric fistula, she underwent simple total hysterectomy for uterine smooth muscle tumor. Small bowel obstruction occurred early and a small bowel bypass was performed. However, she had sudden abdominal pain and was diagnosed with anastomotic leakage of small bowel bypass. Although antibiotic treatment was initiated, infection was difficult to control, and a midline abdominal incision was performed, followed by the formation of enteroatmospheric fistula. She declined early surgical intervention and started receiving home parenteral nutrition with antibiotic treatment. Although central vein management was continued, catheter infection became frequent. Hence, surgical intervention was planned 30 months after the formation of enteroatmospheric fistula. Two-stage abdominal wall reconstruction using open abdomen management with negative pressure wound therapy was planned. The definitive abdominal wall reconstruction was performed 14 days after the initial operation. Finally, she was discharged without reoperation. Discussion Enteroatmospheric fistula has no overlying soft tissue and no real fistula tract. Besides these complications, there were complications of the scarred abdominal wall from intestinal fluid exposure for 30 months. Conclusion The strategy using open abdomen management with negative pressure wound therapy for long-term enteroatmospheric fistula will have a good postoperative outcome with the same as early intervention.

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Management of the open abdomen using negative pressure wound therapy with instillation in severe abdominal sepsis

Cited by 24 publications

References 28 publications

Open Abdomen and Fluid Instillation in the Septic Abdomen: Results from the IROA Study

Open Abdomen and Fluid Instillation in the Septic Abdomen: Results from the IROA Study

Hypochlorous Acid for Septic Abdominal Processes Using a Unique Negative Pressure Wound Therapy System: A Pilot Study

The successful management for long-term intractable enteroatmospheric fistula: A case report

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