Khirurgiia · 2025
[Vacuum-assisted laparostomy for diffuse postoperative peritonitis in patients with abdominal cancers].
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Uvarov I B, Manuilov A M, Sichinava D D
Аннотация
OBJECTIVE: To improve the outcomes in patients with abdominal cancers complicated by diffuse postoperative peritonitis (DPP) using vacuum-assisted laparostomy (VAL) with elective staged peritoneal lavage.
MATERIAL AND METHODS: There were 141 patients with DPP: group I (63 patients) - VAL, group II (78 patients) - redo laparotomy on demand (RD). Negative pressure therapy was performed using commercial vacuum systems with vacuum dressing changes after 48 - 72 hours. We assessed mortality, morbidity, abdominal cavity status (Björck classification) and incidence of primary fascial closure of abdominal cavity.
RESULTS: There were 10 (15.9%) and 24 (30.8%) deaths, respectively (p=0.040). Complications Clavien-Dindo grade 3-5 were significantly more common in the 2nd group. According to the Björck classification, grades 2A (39.7%) and 2B (41.3%) became more common after the 2nd peritoneal lavage in the 1st group. After the 3rd and further staged peritoneal lavages, «frozen open abdomen» (grade 3A and 4) prevailed. This classification revealed significant correlations with abdominal index, intra-abdominal hypertension and C-reactive protein. Primary fascial closure of abdominal cavity was performed in 40 (63.5%) patients in the 1st group.
CONCLUSION: Vacuum-assisted laparostomy is effective for diffuse postoperative peritonitis compared to on-demand relaparotomy. This approach provides lower mortality and morbidity rates, as well as better control over local inflammatory process and intra-abdominal pressure.
MATERIAL AND METHODS: There were 141 patients with DPP: group I (63 patients) - VAL, group II (78 patients) - redo laparotomy on demand (RD). Negative pressure therapy was performed using commercial vacuum systems with vacuum dressing changes after 48 - 72 hours. We assessed mortality, morbidity, abdominal cavity status (Björck classification) and incidence of primary fascial closure of abdominal cavity.
RESULTS: There were 10 (15.9%) and 24 (30.8%) deaths, respectively (p=0.040). Complications Clavien-Dindo grade 3-5 were significantly more common in the 2nd group. According to the Björck classification, grades 2A (39.7%) and 2B (41.3%) became more common after the 2nd peritoneal lavage in the 1st group. After the 3rd and further staged peritoneal lavages, «frozen open abdomen» (grade 3A and 4) prevailed. This classification revealed significant correlations with abdominal index, intra-abdominal hypertension and C-reactive protein. Primary fascial closure of abdominal cavity was performed in 40 (63.5%) patients in the 1st group.
CONCLUSION: Vacuum-assisted laparostomy is effective for diffuse postoperative peritonitis compared to on-demand relaparotomy. This approach provides lower mortality and morbidity rates, as well as better control over local inflammatory process and intra-abdominal pressure.