SERACETTIN EĞIN, BERK GÖKÇEK, METIN YEŞILTAŞ, SEMIH HOT, SEDAT KAMALI, RıZA GÜRHAN IŞIL, HASAN TOK, SERVET RÜŞTÜ KARAHAN
Sağlik Bilimleri Üniversitesi, Okmeydani Education and Research Hospital, Istanbul, Turkey
Introduction: In the literature, there are studies comparing open abdomen technique and primary closure technique in terms of survival and other results in patients with surgical abdominal sepsis. There are no studies investigating the factors affect- ing survival in patients treated with open abdominal technique alone. These factors should be investigated retrospectively in open abdomen patients. We aimed to investigate the factors affecting survival in patients with severe intraabdominal sepsis treated with vacuum-assisted closure systems for open abdomen. We hypothesized that use of open abdomen with vacuum-assisted closure sys- tems was reduced mortality in patients with severe intraabdominal sepsis.
Materials and methods: We retrospectively reviewed 40 open abdomen patients performed vacuum-assisted closure for severe intraabdominal sepsis. Alive and mortal groups were evaluated in terms of age, gender, body mass index, etiology of surgi- cal abdominal sepsis, Apache II score, Mannheim peritonitis index score, Bjorck classification, fascia score, abdominal defect size, stoma and fistula presence, and vacuum-assisted closure treatment duration. It was evaluated whether any of these parame- ters was effective on survival.
Results: Mean age and body mass index were significantly elevated in the mortal group compared with the alive group. A significant difference with regard to Bjorck classification was detected between the alive and mortal groups. In Bjorck 1 and 2, mortality rates were 36.8% and 31.3%, respectively, while in Bjorck 4, mortality was 100%. The presence and type of fistula were statistically significant for mortality. None of the other parameters were statistically significant for mortality.
Discussion: The studies of the last twelve years showed that the open abdomen technique with the temporary abdominal wall closure using negative pressure dressing methods gave positive results. The 42.5% mortality rate in our study is much lower than the mortality rate for abdominal sepsis patients in the literature. Our study indicated that the management of open abdomen and negative pressure therapy was possible to increase the survival in patients with surgical abdominal sepsis.
Abdominal sepsis, Open abdomen, Vacuum-assisted closure, Negative pressure therapy