Temporary abdominal closure techniques in open abdomen: preliminary data of international register of open abdomen (IROA): patient enrollment is still ongoing

A literature review of studies on the use of local negative pressure technique (vacuum therapy) in abdominal surgery is presented. The article highlights modern approaches to its use in emergency pathology of the abdominal cavity and retroperitoneal space. The mechanisms of action, advantages and disadvantages of the local negative pressure technique, as well as the main morphofunctional aspects of its application are discussed in detail. Data from recent clinical studies and meta-analyses are summarized, and the effectiveness of using vacuum-assisted laparostomy within the framework of the «damage control» concept in multi-stage surgical treatment of injuries and urgent abdominal diseases accompanied by abdominal sepsis is demonstrated. The use of local negative pressure techniques can reduce postoperative mortality, as well as shorten the length of hospital treatment of patients. However, despite the obvious positive effect on the course of the wound process, vacuum therapy carries the risk of developing serious complications, the most dangerous of which are bleeding and perforation of hollow organs. In addition, it requires very expensive equipment and consumables, as well as training of medical personnel. Thus, the use of vacuum therapy requires a sound approach and a clear understanding of the technical features of its implementation. However, the indications for the use of local negative pressure in abdominal surgery have not yet been clarified, which undoubtedly hinders the wider introduction of this promising technique into clinical practice.

Local negative pressure technique in abdominal surgery: advantages, disadvantages, controversial issues

Sazonov,

Romashchenko,

Makarov

et al. 2023

Differentiated approach for using vacuum-assisted laparostomy in gunshot abdominal wounds

Sazonov,

Romashchenko,

Makarov

et al. 2024

The OBJECTIVE was to evaluate the results of using vacuum-assisted laparostomy in the surgical treatment of victims with gunshot abdominal wounds and clarify the indications for its use.METHODS AND MATERIALS. A comparative assessment of the results of surgical treatment of 180 victims with gunshot abdominal wounds was carried out. In the retrospective group (90 patients), vacuum-assisted laparostomy was used in accordance with the recommendations of the World Society of Emergency Surgery and national clinical guidelines for the treatment of peritonitis. To clarify the indications for vacuum-assisted laparostomy in patients of the prospective group (n=90), the risk scale for peritonitis progression in gunshot abdominal wounds (priority certificate № 2024100144) was used. The study groups were comparable according to the main clinical criteria: age of victims, severity of injuries, and structure of surgical interventions.RESULTS. In the retrospective group, vacuum-assisted laparostomy was performed in 41 % of cases, in the prospective group – in 56 % of victims. In-hospital mortality was 5.5 % and 2.3 %, respectively (p=0.2). The incidence of complications of grade III–IV according to Clavien–Dindo in the retrospective group was 34.5 %, and in the prospective group – 23.3 % (p = 0.07). At the same time, the progression of peritonitis with the development of abdominal sepsis was noted in 8 patients in the retrospective group and in 2 patients in the prospective group (14.2 % and 3.4 %, p = 0.04).CONCLUSION. Vacuum-assisted laparostomy is the important element of the surgical treatment program for victims with gunshot abdominal wounds, allowing implementation of damage control tactics and providing reliable control over the infectious process. The use of the developed risk scale for peritonitis progression substantiates the indications for vacuum-assisted laparostomy for gunshot abdominal wounds, which helps to reduce the incidence of abdominal sepsis.

Application of vacuum-instillation laparostomy in gunshot abdominal wounds

Romashchenko,

Sazonov,

Maistrenko

et al. 2024

Penetrating abdominal wounds occupy a significant place in the structure of gunshot injuries in peacetime and war. They are usually characterized by extensive multiorgan damage with the development of peritonitis, the course of which largely determines the outcome of treatment. Therefore, the main task in providing specialized surgical care for victims with gunshot abdominal wounds is to relieve peritonitis in order to prevent the generalization of the septic process. One of the modern trends in solving this problem is vacuum-assisted laparostomy. However, data on its use are presented in rare publications and are usually based on small samples of patients with secondary peritonitis. At the same time, we did not find any information in the available sources about the effectiveness of the most promising modification of this technique – vacuum-instillation laparostomy for gunshot abdominal wounds. This article demonstrates the first experience of the successful use of vacuum-instillation laparostomy in a patient with gunshot abdominal wound complicated by abdominal sepsis. The obtained results indicate the high potential of using this technique in this difficult category of patients.