Vacuum-assisted closure of laparostomy, an efficient strategy for complicated intra-abdominal infection

Introduction

The chirurgical strategy for infection control in complicated intra-abdominal infections is responsible alone for 40% reduction in mortality. The second look strategy in tertiary peritonitis reduces the mortality and morbidity of the patients. Vacuum-assisted closure therapy can potentially decrease the concentration of proinflammatory cytokines, bacterial count, management of third-space fluid and improved input and output monitoring.

Methods

The authors present a revision of 60 patients with tertiary peritonitis admitted to the ICU after chirurgical infection control. All patients have septic shock at admission. Twelve percent of them were admitted with an open abdomen and vacuum-assisted closure therapy was used. The parameters evaluated were hospital mortality, ICU stay (days) and time of mechanical ventilation (days).

Results

The patients submitted to vacuum-assisted closure therapy were similar to patients in whom the abdominal wall was closed, regarding the risk factors for peritoneal infection (corticotherapy, oncologic disease, renal insufficiency, hepatic insufficiency, desnutrition, hypoalbuminemia, a high APACHE II score). The patients submitted to vacuum-assisted closure therapy had a higher ICU stay and time of mechanical ventilation but lower hospital mortality.

Conclusions

Vacuum-assisted closure therapy is superior to primary abdominal wall closure in patients with tertiary peritonitis.