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

Abstract

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.

Successful Use of Negative Pressure Wound Therapy for Abdominal Wall Necrosis Caused by a Perforated Ascending Colon Using the ABThera System

“…However, patients with OA do require temporary abdominal closure (TAC) to allow for a period of optimization prior to definitive closure. There are multiple techniques associated with the management of OA that can be used to facilitate TAC, such as loose packing of the abdominal cavity [1], use of towel clips [2], placement of mesh materials [3], use of polyvinyl bags [4], or even use of textile and zipper-like devices [5]. Until 2016, there was no consensus as to which treatment option was superior, although various studies indicated that negative pressure wound therapy (NPWT) and its variants were the most effective approach, yielding the best results and reducing associated complications [6].…”

“…Patients with an open abdomen (OA) require temporary abdominal closure (TAC) to allow for a period of stabilization prior to definitive closure. There are multiple techniques to facilitate TAC in the management of an OA [ 1 – 5 ]. Among these techniques, negative pressure wound therapy (NPWT) is the most effective approach [ 6 ].…”

Ventral abdominal wall defect correction in rats with contaminated meshes

“…Materials such as polypropylene, polyglactin, polytetrafluoroethylene, woven polyester, polyvinylidene, among others, may be part, alone or in combination, of the composition of meshes currently used [7][8][9][10][11][12] .…”

Open abdomen management: single institution experience

“…Since 1981, the Department of General Surgery and Trauma Hospital of the Faculty of Medicine, Universidade de São Paulo (HCFMUSP), it was established that the open abdomen (AA) with planned reoperations would be an option for the treatment of intra-infections abdominal with systemic repercussions, whose infectious focus could not be removed in one operation 9 . In the 90's was designed the Damage Control (DC).…”