>Cirugía y Cirujanos
>Year 2010, Issue 4
López-Quintero L, Evaristo-Méndez G, Fuentes-Flores F, Ventura-González F, Sepúlveda-Castro R
Treatment of open abdomen using the vacuum pack system in patients with abdominal sepsis
Cir Cir 2010; 78 (4)
PDF: 293.92 Kb.
Background: In abdominal sepsis, when the initial surgery fails to control infection, a good choice may be to leave the abdomen open. This is a descriptive study of a series of cases using the vacuum pack system for temporary abdominal closure.
Methods: We studied 19 patients. Demographic data were obtained, as well as those related to the vacuum pack, and the final fascial closure. We describe the technique of temporary abdominal closure. Values are presented as mean ± standard deviation (SD).
Results: The average length of the hospital stay was 24.7 days. Fourteen (73.7%) patients survived and five patients (26.3%) died. The mean treatment time with the vacuum pack was 12.7 days, with an average of 3.9 changes. Early fascial closing was achieved in seven patients with an average of 14.6 days. In seven patients a planned ventral hernia formed, which was repaired by separation of components on an average of 261 days or by polypropylene mesh on an average of 228 days.
Conclusions: In our series, early fascial closing was achieved using the vacuum pack at a lower frequency than reported by other authors. Other parameters analyzed were similar to those reported in the literature. The vacuum pack system demonstrated to be effective, although the final selection for temporary abdominal closure will depend on the experience of the institution as well as surgeon preference. The vacuum pack system for temporary abdominal closure of the open abdomen is an effective alternative in patients with abdominal sepsis.
||Abdominal sepsis, open abdomen, temporary abdominal closure.
Schecter WP, Ivatury RR, Rotondo MF, Hirshberg A. Open abdomen after trauma and abdominal sepsis: a strategy for management. J Am Coll Surg 2006;203:390-396.
van Ruler O, Mahler CW, Boer KR, Reuland EA, Gooszen HG, Opmeer BC, et al. Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis: a randomized trial. JAMA 2007;298:865-872.
Hau T, Ohmangn C, Wolmershauser A, Wacha H, Yang Q. Planned relaparotomy vs relaparotomy on demand in the treatment of intraabdominal infections. Arch Surg 1995;130:1193-1196.
Barker DE, Green JM, Maxwell RA, Smith PW, Mejía VA, Dart BW, et al. Experience with vacuum-pack temporary abdominal wound closure in 258 trauma and general and vascular surgical patients. J Am Coll Surg 2007;204:784-792.
Myers JA, Latenser BA. Nonoperative progressive “Bogotá bag” closure after abdominal decompression. Am Surg 2002;68:1029-1030.
Buck JR, Fath JJ, Chung SK, Sorensen VJ, Horst HM, Obeid FN. Use of absorbable mesh as an aid in abdominal wall closure in the emergent setting. Am Surg 1995;61:655-658.
Nagy KK, Fildes JJ, Mahr C, Roberts RR, Krosner SM, Joseph KT, etal. Experience with three prosthetic materials in temporary abdominal wall closure. Am Surg 1996;62:331-335.
Aprahamian C, Wittmann DH, Bergstein JM, Quebbeman EJ. Temporaryabdominal closure (TAC) for planned relaparotomy (etappenlavage) in trauma. J Trauma 1990;30:719-723.
Tremblay LN, Feliciano DV, Schmidt J, Cava RA, Tchorz KM, Ingram WL, et al. Skin only or silo closure in the critically ill patient with an open abdomen. Am J Surg 2001;182:670-675.
Miller PR, Meredith JW, Johnson JC, Chang MC. Prospective evaluation of vacuum-assisted fascial closure after open abdomen: planned ventral hernia rate is substantially reduced. Ann Surg 2004;239:608- 614.
Brock WB, Barker DE, Burns RP. Temporary closure of open abdominal wounds: the vacuum-pack. Am Surg 1995;61:30-35.
Barker DE, Kaufman HJ, Smith LA, Ciraulo DL, Richart CL, Burns RP. Vacuum-pack technique of temporary abdominal closure: a 7-year experience with 112 patients. J Trauma 2000;48:201-206.
Schein M, Saadia R, Jamieson JR, Decker GA. Aggressive treatment of severe diffuse peritonitis: a prospective study. Br J Surg 1988;75:173-176.
Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound closure and treatment: clinical experience. Ann Plast Surg 1997;38:563-576.
Garner GB, Ware DN, Cocanour CS, Duke JH, McKinley BA, KozarRA, et al. Vacuum-assisted wound closure provides early fascialre approximation in trauma patients with open abdomens. Am J Surg 2001;182:630-638.
Tavares LD, Andrade PD, Goné AF, Sánchez PF. Abdomen abierto. Evolución en su manejo. Cir Cir 2008;76:177-186.
Ramírez OM, Ruas E, Dellon AL. Components separation method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 1990;86:519-526.
Hirshberg A, Stein M, Adar R. Reoperation planned and unplanned. Surg Clin North Am 1997;77:897-907.
Cipolla J, Stawicki SP, Hoff WS, McQuay N, Hoey BA, Wainwright G, et al. A proposed algorithm for managing the open abdomen. Am Surg 2005;71:202-207.
Suliburk J, Ware D, Balogh Z, McKinley BA, Cocanour CS, Kozar RA, et al. Vacuum-assisted wound closure achieves early fascial closure of open abdomens after severe trauma. J Trauma 2003;55:1155-1160.
Teicher EJ, Pasquale MD, Cipolle MD. Abdominal compartment syndrome operative. OTGS 2008;10:39-59.
Wondberg D, Zingg U, Metzger U, Platz A. VAC abdominal dressing system in left open abdomen patients with secondary peritonitis. Br J Surg 2006;93:1161.
Expósito ME, Aragón FP, Curbelo RP, Pérez JA, López MF. Manejo de las peritonitis graves. Nuestra experiencia con abdomen abierto (1994-1998) y con relaparotomías programadas (1999-2000). Cir Cir 2002;70:31-35.
>Cirugía y Cirujanos
>Year 2010, Issue 4