["Abdominal dressing" - a new method of treatment for open abdomen following secondary peritonitis].
BACKGROUND
Treatment of open abdomen following secondary peritonitis is a challenge for surgery and intensive care units (ICU). The aim of this study was to compare three different concurrent treatment strategies.


METHODS
Patients suffering an open abdomen following surgery for secondary peritonitis at the Department of General Surgery from 01/01 to 12/03 were investigated. Factor studied: duration of open abdomen, incidence of multi-organ failure, need for surgical revisions, length of stay (LOS) in ICU, nursing requirements (change of dressing/day), survival and integrity of abdominal wall after discharge. Treatment strategies included: open packing (OP), classic vacuum assisted (V.A.C.(R))-therapy with silicone net protection for the intestine (CV) and V.A.C.(R)-therapy with "abdominal dressing" a newly developed meshed polyvinyl wrap (AD).


RESULTS
21 patients were studied: 5 patients were treated with OP, 8 patients with CV and 8 patients with AD. Mean LOS was 65 (OP) vs. 53 (CV) vs. 42 (AD) days (NS), peritonitis related death was 3 (OP) vs. 1 (CV) vs. 0 (AD) (p < 0.05 Chisquare test). Median nursing effort was 4 dressings/day (OP), 0.5 (CV) and 0.5 (AD) (p < 0.005 OP vs CV, AD Kruskal-Wallis test).


CONCLUSIONS
The "abdominal dressing"-therapy seems to be a more efficient treatment option in patients suffering from open abdomen following secondary peritonitis. A trend towards shorter ICU-LOS, lower mortality rates and reduced nursing requirements support our hypothesis.
Wild
T
T
Universitätsklinik für Chirurgie, Klinische Abteilung für Allgemeinchirurgie, Medizinische Universität, AKH Wien. thomas.wild@akh-wien.ac.at
Stremitzer
S
S
Budzanowski
A
A
Rinder
H
H
Tamandl
D
D
Zeisel
C
C
Hölzenbein
T
T
Sautner
T
T
D003422:Critical Care / Q000706:statistics & numerical data; D003646:Debridement / Q000295:instrumentation*; D004867:Equipment Design; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008838:Microcomputers; D009779:Occlusive Dressings; D010538:Peritonitis / Q000401:mortality / Q000601:surgery*; D011142:Polyvinyl Alcohol; D012086:Reoperation; D012828:Silicones; D025321:Surgery, Computer-Assisted / Q000295:instrumentation; D013526:Surgical Mesh; D015503:Surgical Sponges; D013530:Surgical Wound Infection / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D013536:Suture Techniques / Q000295:instrumentation*; D013673:Technology Assessment, Biomedical; D014618:Vacuum; D014945:Wound Healing / Q000502:physiology
D012828:Silicones; D011142:Polyvinyl Alcohol