title: Evaluation of prosthetic mesh closure in semiopen-abdomen patients.
abstract: BACKGROUND
  To avoid the adverse consequences of abdominal compartment syndrome and to reduce the high mortality the celiotomy wound in patients with abdominal sepsis was closed without tension using prosthetic mesh. This produces a semiopen situation that permits staged reinterventions together with the functional reconstitution of the continuity of the abdominal wall.
  
  
  METHODS
  Twenty-five patients with intra-abdominal sepsis of various causes were evaluated retrospectively to assess the results of semiopen management of the septic abdomen and reoperations on demand in severe peritonitis. All of the patients were in a state of neglected peritonitis, and had at least one failing organ system. The Mannheim Peritonitis Index (MPI) scoring system was used for stratification of abdominal sepsis.
  
  
  RESULTS
  The mean MPI score of 25 patients was 24, ranging 10 to 33. Eight (32%) patients were reexplored (MPI=21). There were overall 9 (36%) complications in patients with mean MPI score of 23. Six (24%) mesh-related complications (infection and enterocutaneous fistulas) developed (MPI=19). The mean MPI score of patients without complications was 24. Four (16%) patients died with index MPI score of 26 due to fulminant hepatitis, myocardial infarction, and multiple organ failure. The admission period averaged 63 days.
  
  
  CONCLUSIONS
  In 25 critically ill patients with abdominal sepsis the mortality was lower than expected, relative to heterogeneous data from the literature; also, major complications occurred less frequently although the mean MPI score was high. The authors conclude that this approach is a reliable contribution to the complex treatment of these patients.
authors.affiliation: Department of Surgery, Dokuz Eylul University School of Medicine, Izmir, Turkey. selman. sokmen@deu. edu. tr
authors.forename: S
authors.initials: S
authors.lastname: Sökmen
authors.forename: K
authors.initials: K
authors.lastname: Atila
authors.forename: S
authors.initials: S
authors.lastname: Bora
authors.forename: H
authors.initials: H
authors.lastname: Astarcioğlu
authors.forename: A
authors.initials: A
authors.lastname: Coker
authors.forename: M
authors.initials: M
authors.lastname: Füzün
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003422:Critical Care; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007813:Laparotomy / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000601:surgery; D010538:Peritonitis / Q000209:etiology* / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000150:complications; D012720:Severity of Illness Index; D013526:Surgical Mesh; D013536:Suture Techniques