Fascial closure of the abdominal wall by dynamic suture after topical negative pressure laparostomy treatment of severe peritonitis – results of a prospective randomized study

Czech version

Authors: Z. Šerclová ¹; O. Ryska ¹; P. Dytrych ¹; J. Marvan ¹; K. Marx ¹; E. Konečná ¹; A. Mikšíková ²; F. Antoš ¹
Authors‘ workplace: Chirurgická klinika NNB, Praha, přednosta: Doc. MUDr. Jan Fanta DrSc. ¹; Oddělení klinické biochemie a hematologie NNB, Praha, primář: MUDr. Eugen Liška ²
Published in: Rozhl. Chir., 2012, roč. 91, č. 1, s. 26-31.
Category: Original articles

Overview

Introduction:
Severe peritonitis is a frequent condition characterized by high morbidity and mortality rates. Topical negative pressure (TNP) laparostomy could improve the results of the treatment, provided that the adverse events of this method are reduced. The aim of our study was to prove, in a prospective randomized study, that the primary use of TNP laparostomy reduces morbidity and mortality when compared to primary abdominal wall closure after the index surgery for severe peritonitis. The possibility of the abdominal wall fascial closure significantly influencing morbidity was the main topic of this study.

Material and methods:
Between 9/2009 and 9/2011, 57 patients with severe peritonitis were included in the study at the Department of Surgery of the Bulovka Faculty Hospital; 28 of them were randomized to the TNP laparostomy group and 29 to the primary closure group. The two groups did not differ in age, gender, polymorbidity and severity of peritonitis.

Results:
The length of hospital stay was similar in both groups (median: 22 days; range 10–171 days) in the intervention group and 23 days (range 3–71) in the control group (p = 0.89). The mortality rate was significantly lower in the TNP laparostomy group in comparison with the primary closure group (3 patients, 11% vs. 12 patients, 41%; p = 0.01). A complete closure of the abdominal wall including fascia and complete abdominal wall healing was achieved in 80% of survivors in the TNP group, compared to 29% in the primary closure group (p = 0.01). No enteral fistula occurred in any surviving patients from both groups. The overall length of abdominal wall healing was significantly shorter in the TNP group (median: 7; 7–94 days, versus 30; 7–223; p = 0.04).

Conclusions:
Primary TNP laparostomy is an effective and safe method in the treatment of severe peritonitis. Keeping good clinical practice, especially using dynamic suture as early as after the index surgery and the timely closure of laparostomy as soon as the indication disappears (according to relevant criteria) leads to a significantly higher abdominal wall healing rate, icluding fascial closure, than after peritonitis treatment without laparostomy.

The study was supported by a grant from the Ministry of Health of the Czech Republic:
NS 10466-3/2009.

Key words:
topical negative pressure laparostomy – dynamic suture of the abdominal wall – severe peritonitis

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Article was published in

Perspectives in Surgery

2012 Issue 1