Initial experience of laparostomy with immediate vacuum therapy in patients with severe peritonitis.
BACKGROUND
To report our initial experience of laparostomy and immediate intra-abdominal vacuum therapy in patients with severe peritonitis due to intra-abdominal catastrophes.


METHODS
Twenty-seven patients underwent emergency laparotomy and laparostomy formation with the application of immediate intra-abdominal TRAC-VAC therapy (male:female ratio, 1:1.2; median age, 73 years; range, 34-84 years). Predicted mortality was assessed using the P-POSSUM score and compared with clinically observed outcomes.


RESULTS
Ten patients (37%) with a mean predicted P-POSSUM mortality of 72%, died of sepsis and multi-organ failure. Seventeen patients (mean P-POSSUM 48% expected mortality) survived to discharge. One patient with pancreatitis died from small bowel obstruction 1-year post discharge, two patients developed a small bowel fistula. One patient had an allergic reaction to the VAC dressing. Our patients, treated with laparostomy and TRAC VAC therapy, had a significantly improved observed survival when compared to P-POSSUM expected survival (P = 0.004).


CONCLUSIONS
Laparostomy with immediate intraperitoneal VAC therapy is a robust and effective system to manage patients with intra-abdominal catastrophes. There were significantly improved outcomes compared to the mortality predicted by P-POSSUM scores. Damage control surgery with laparostomy formation and intra-abdominal VAC therapy should be considered in patients with severe peritonitis.
Department of General Surgery, Glan Clwyd Hospital, Rhyl, UK.
James
J
Horwood
Fayaz
F
Akbar
Andrew
A
Maw
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003161:Compartment Syndromes / Q000517:prevention & control; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D010538:Peritonitis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D018805:Sepsis / Q000209:etiology / Q000401:mortality; D054047:Surgical Stomas; D015996:Survival Rate; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology