title: Laparostomy with topical negative pressure for treating severe peritonitis. Preliminary experience with 16 cases and review of the literature.
abstract: BACKGROUND
  The aim of this study was to assess the authors' initial experience with laparostomy and intraperitoneal topical negative pressure (TNP) in patients with severe peritonitis. The authors also reviewed the recent literature on the effectiveness and safety of abdominal TNP.
  
  
  METHODS
  Sixteen patients (10 male, 6 female, mean age 55 years), suffering from severe peritonitis, underwent emergency laparotomy and laparostomy with TNP. Abdominal sepsis originated from the small intestine (n = 7), large intestine (n = 6), biliary tract (n = 2), and pancreas (n = 1). In 2 patients abdominal wall mesh infection and soft tissue gangrene were observed.
  
  
  RESULTS
  The mortality rate was 31.2%. The main complications probably related to TNP were enteric fistulae (25%), bleeding (25%), abdominal abscesses (12.5%), bowel ischemia (6.2%). Delayed primary closure was performed in 8 patients (57.1%) whereas in 6 cases a parietal graft was necessary, and one patient underwent an autologous skin graft.
  
  
  CONCLUSIONS
  Laparostomy with intraperitoneal TNP is a safe and effective method for managing patients with severe peritonitis. Morbidity can be reduced through individualized application of the laparostomy dressing and pressure gradient. The abdominal wall should be managed in such a way as to make possible delayed primary closure.
authors.forename: Ciro
authors.initials: C
authors.lastname: De Martino
authors.forename: Paolo
authors.initials: P
authors.lastname: Caiazzo
authors.forename: Michele
authors.initials: M
authors.lastname: Albano
authors.forename: Francesco
authors.initials: F
authors.lastname: Calbi
authors.forename: Mauro
authors.initials: M
authors.lastname: Pastore
authors.forename: Pio Rocco
authors.initials: PR
authors.lastname: Tramutoli
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D010529:Peritoneal Cavity / Q000601:surgery*; D010538:Peritonitis / Q000628:therapy*; D012720:Severity of Illness Index; D055815:Young Adult