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

Abstract

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.

WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections

“…Open abdomen combined with negative pressure therapy and fluid instillation is taking this therapeutic concept one step further, and results are promising [ 35 , 36 ]. Severe complications including loss of the abdominal domain, fistula formation, and the development of giant incisional hernias may be observed when leaving the abdomen open without active closure device.…”

Optimized Treatment of Nosocomial Peritonitis

“…Bowel anastomosis and negative pressure were not associated with an increased EAF risk [118,119]. This was found in all patients in the IROA study, including elderly and obese patients and those who were treated with intra-abdominal fluid instillation [120][121][122].…”

Hybrid Double-Sided Tape with Asymmetrical Adhesion and Burst Pressure Tolerance for Abdominal Injury Treatment

“…The mortality rate among patients with open abdominal (OA) wounds can be as high as 30% . These conditions typically arise from abdominal trauma or postoperative incisional dehiscence, leading to the exposure of intra-abdominal organs. − Immediate and primary interventions are essential for closing OA wounds, protecting exposed organs, and preventing serious side effects like intestinal fistula. − Unfortunately, there are problems with rubbing exposed intestinal tubes with current temporary abdominal closure (TAC) materials such as polypropylene mesh. This can result in intestinal damage, rupture, or even the establishment of intestinal fistulas. − A biocompatible TAC material that can successfully repair abdominal wall defects and provide a closed intra-abdominal environment is desperately needed.…”