[Role of vacuum therapy in the management of the septic abdomen].
Progress in intensive care medicine contributed substantially in lowering the mortality rate of patients suffering from diffuse secondary peritonitis. In the medical care of patients presenting a septic abdomen the persisting septic focus is one of the greatest problems. This is associated with other problems like temporary closure of the abdomen, complications due to re-laparotomies, healing of the abdominal wall after soft tissue infection, loss of abdominal wall musculature, or persisting enteral fistulas. The vacuum therapy is used with increasing frequency for the treatment of septic complications in different areas of the body. The excellent drainage characteristics of the vacuum therapy appear to be a therapeutic option for the control of surgically untreatable septic processes in the abdominal cavity. More and more experience is gathered with the successful treatment of enterocutaneous fistulas, small intestine and pancreatic fistulas as well as anastomotic leakage after rectal surgery. There exist hardly any evidence-based recommendations for the application of vacuum therapy for treatment of the septic abdomen. But the good results of temporary closure of open abdomen of trauma patients by the vacuum therapy arises hope that the results can be transferred to the treatment modalities of persisting peritonitis. Additionally, these patients could profit from the drainage characteristics of the vacuum therapy.
Chirurgische Klinik und Poliklinik Grosshadern, Klinikum der Universität München, Ludwig-Maximilians-Universität München. rolf.weidenhagen@med.uni-muenchen.de
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Weidenhagen
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Grützner
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Kopp
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Spelsberg
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Jauch
D034861:Abdominal Wall / Q000601:surgery; D003131:Combined Modality Therapy; D003422:Critical Care; D006801:Humans; D007412:Intestinal Fistula / Q000601:surgery; D009779:Occlusive Dressings; D010538:Peritonitis / Q000209:etiology / Q000601:surgery*; D011182:Postoperative Care; D012086:Reoperation; D013529:Surgical Wound Dehiscence / Q000601:surgery; D013530:Surgical Wound Infection / Q000601:surgery*; D014618:Vacuum