[Abdominal dressing -- a new standard in therapy of the open abdomen following secondary peritonitis?].
BACKGROUND
The management of patients with a laparostoma due to peritonitis is a challenge for every surgeon and intensivist. The goal of this study was to compare the different treatment strategies for the open abdomen: Abdominal Dressing (AD), the classic V.A.C. therapy (CV) and conventional open therapy (CT).


METHODS
Between 2001 and 2005 we identified 62 patients in 4 surgical departments in Austria who had to be treated with a laparostoma due to peritonitis. 27 patients were conventionally treated, 16 with the Classic V.A.C. therapy and 19 patients with V.A.C. abdominal dressing.


RESULTS
The mortality was 3/16 (14 %) in the AD group vs. 4/12 (21 %) patients in the CV group and 18/9 (59 %) in conventional therapy. There was no significant difference for survivors in the length of ICU stay: 26.6 +/- 23.0 days in the CT group, 34.6 +/- 30.2 days in the CV group and 38.9 +/- 27.2 days in the AD group. Apache II Score and Mannheimer Peritonitis Score showed no difference between the groups.


CONCLUSIONS
We found a reduction of mortality in the V.A.C. Abdominal Dressing group by approximately 40 % (AD: 14 %, CT: 59 %). Although we could identify a difference in age in our retrospective study we believe that V.A.C. Abdominal Dressing is the important factor for the different clinical outcome. These first results indicate the need for further prospective evaluation of the V.A.C. Abdominal Dressing therapy, to prove if a new standard in the therapy of the open abdomen is created.
Medical University of Vienna, Department of Surgery, Division of General Surgery, General Hospital of Vienna. thomas.wild@meduniwien.ac.at
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Wild
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Stortecky
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Stremitzer
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Lechner
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Humpel
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Glaser
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Fortelny
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Karner
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Sautner
D018806:APACHE; D000005:Abdomen / Q000601:surgery*; D001458:Bandages; D003646:Debridement; D006801:Humans; D009779:Occlusive Dressings; D010043:Outcome and Process Assessment, Health Care; D010538:Peritonitis / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis; D013536:Suture Techniques; D014618:Vacuum