[Vacuum-instillation laparostomy for gunshot peritonitis].

Abstract

Objective. t: O evaluate efficacy of vacuum instillation laparostomy in the treatment of victims with gunshot peritonitis.

Material and methods: We analyzed treatment outcomes in 103 victims with gunshot abdominal wounds complicated by peritonitis. All patients underwent multi-stage surgical treatment with vacuum-instillation laparostomy (VIL) in the main group (n=37) and vacuum-assisted laparostomy (VAL) in the control group (n=66). Negative pressure was 90 mm Hg due to high risk of bleeding following traumatic disease. The interval between debridement did not exceed 48 hours. VIL was carried out in the following format: duration of vacuum phase 3 hours 30 minutes, volume of injected solution 300 ml, exposure time 30 minutes.

Results: Complications occurred in 32.4% and 43.9% of patients, respectively (p>0.05). There was a tendency towards significant differences (p=0.07) in the incidence of complications Clavien-Dindo grade III-IV (13.5% and 30.3%). In-hospital mortality was 3% and 6%, respectively (p>0.05). Bacteriological analysis revealed faster achievement of target indicators of microflora elimination in VIL (the 7^th day) compared to VAL (the 11^th day). Adhesive process following VIL was significantly less severe. Indeed, there was Björck stage 1B and 2B of abdominal cavity by the 4^th debridement in majority of patients in both groups, respectively. These changes correlated with histological findings. VIL was accompanied by faster regression of leukocyte infiltration and less severe fibrous changes.

Conclusion: VIL provides more effective abdominal decontamination and less severe adhesive process compared to VAL. This reduces the number of debridement procedures and risk of complications.