Sequential abdominal reexploration with the zipper technique

OBJECTIVE: to present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. METHODS: we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years); 11 patients were male, and four were female. RESULTS: forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. CONCLUSION: the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.

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“…After the literature review, 12 articles were selected 16,[18][19][20][21][22][23][24][25][26][27][28] (Table 2).…”

Section: Results Results Results Resultsmentioning

confidence: 99%

Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis

Utiyama

Pflug

Damous

et al. 2015

Rev. Col. Bras. Cir.

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“…The absorbable meshes have little tensile strength and can result in evisceration during patient turning with the non-absorbables being associated with a moderate rate of intestinal fistula. 196,197 The further advantages of the VAC proprietary devices over temporary mesh usage include their versatility to the contour of large defects permitting the utilization of a laterally placed stoma in conjunction 198 and potential use even in the presence of a pre-existing intestinal fistula. 199 Where possible, stomas should be avoided as the geography of the abdominal wall may change in such a way that they retract significantly or where in a delayed setting they can compromise abdominal wall reconstruction and rectus advancements.…”

Section: Surgical Decompressionmentioning

confidence: 99%

mentioning

confidence: 99%

Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment

Ap¹,

Wun²,

Chiappa³

et al. 2015

Emerg Med Open J

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Abdominal Compartment Syndrome (ACS) is a potentially lethal condition caused by various events that produce intra-abdominal hypertension. The most common cause is blunt abdominal trauma. Increasing intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines and other peritoneal and retroperitoneal structures. Pathophysiological effects include release of cytokines, production of oxygen free radicals, and decreased cellular formation of adenosine triphosphate. These processes may lead to translocation of bacteria from the gut and intestinal edema, predisposing patients to multiorgan dysfunction syndrome. The consequences of abdominal compartment syndrome are profound and affect many vital body systems. Respiratory, hemodynamic, cardiovascular, renal, and neurological abnormalities are signs of abdominal compartment syndrome. Medical management of critically ill patients with raised intra-abdominal pressure should be instigated early to prevent further organ dysfunction and to avoid progression to ACS. Many treatment options are available and are often part of routine daily management in the ICU (nasogastric, rectal tube, prokinetics, enema, sedation, body position). Some of the newer treatments are very promising options in specific patient populations with raised IAP. Nursing care involves vigilant monitoring for early detection, including serial measurements of intra-abdominal pressure.KEYWORDS: Intra-abdominal hypertension; Abdominal compartment syndrome; Damage control laparotomy; Laparostomy; Open abdomen. DEFINITIONS, INCIDENCE AND MEASUREMENT STRATEGIES IN INTRA-ABDOMINAL HY-PERTENSION (IAH) AND ABDOMINAL COMPARTMENT SYNDROME (ACS)The concept of the Abdominal Compartment Syndrome (ACS) has been rediscovered as a final common pathway of the physiologic sequelae of increased Intra-Abdominal Pressure In each case if the graph shifts to the right, higher IAP and lower APP values may not be associated with significant end-organ dysfunction creating a degree of "ACS-resistance." Shifts to the left would create "ACS-sensitivity" where lower values of IAP (higher APP values) may still be associated with organ dysfunction which might not occur normally. This results in difficulty for broader acceptance of critical IAP and APP levels for individual cases. ACS-sensitivity may potentially occur in patients where there is pre-existing partial end-organ failure, morbid obesity or following fluid hyper-resuscitation in patients with severe burns, haemorrhagic pancreatitis, massive blood loss, widespread intra-peritoneal sepsis and high-output intestinal fistulae. 6-8There is no strict definition of what represents abnormal IAP, but there is a general acceptance that measured pressures >12 mmHg when recorded 1-6 hours apart are considered to represent IAH, where Sugrue, et al. have shown that this represents up to 40% of cases admitted to a surgical Intensive Care Unit (ICU). 9 Although there are biases in the prospective assessment of a selective population admitted to an ICU who ...

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“…Weitere Komplikationen können enterale Fisteln (15%-29%), intraabdominelle Abszesse (11-31%) sowie Blutungen (18-24%) sein [1,4,9,14,22,28,29]. Nach einer längeren Therapie mittels offenem Abdomen kann es aufgrund der Faszienretraktion und der Adhäsionen zwischen Darm und Bauchdecke in bis zu 82% der Fälle unmöglich werden, das Abdomen primär zu verschließen [1,9] [1,7,9,14,29]. Unter der abdominellen Vakuumtherapie wird eine Fistelrate von 0-7% berichtet [3,5,12,16,17,21,23,26].…”

Section: Diskussionunclassified