[Vacuum-assisted laparostomy for diffuse postoperative peritonitis in patients with abdominal cancers].

Abstract

Objective: To improve the outcomes in patients with abdominal cancers complicated by diffuse postoperative peritonitis (DPP) using vacuum-assisted laparostomy (VAL) with elective staged peritoneal lavage.

Material and methods: There were 141 patients with DPP: group I (63 patients) - VAL, group II (78 patients) - redo laparotomy on demand (RD). Negative pressure therapy was performed using commercial vacuum systems with vacuum dressing changes after 48 - 72 hours. We assessed mortality, morbidity, abdominal cavity status (Björck classification) and incidence of primary fascial closure of abdominal cavity.

Results: There were 10 (15.9%) and 24 (30.8%) deaths, respectively (p=0.040). Complications Clavien-Dindo grade 3-5 were significantly more common in the 2^nd group. According to the Björck classification, grades 2A (39.7%) and 2B (41.3%) became more common after the 2^nd peritoneal lavage in the 1^st group. After the 3^rd and further staged peritoneal lavages, «frozen open abdomen» (grade 3A and 4) prevailed. This classification revealed significant correlations with abdominal index, intra-abdominal hypertension and C-reactive protein. Primary fascial closure of abdominal cavity was performed in 40 (63.5%) patients in the 1^st group.

Conclusion: Vacuum-assisted laparostomy is effective for diffuse postoperative peritonitis compared to on-demand relaparotomy. This approach provides lower mortality and morbidity rates, as well as better control over local inflammatory process and intra-abdominal pressure.