Vacuum-assisted closure better in open-abdomen management of severe diffuse peritonitis

Last Updated: 2015-03-25

By Will Boggs MD

NEW YORK (Reuters Health) - Vacuum-assisted closure (VAC) may be superior to mesh-foil laparostomy (MFL) without negative pressure for managing patients with diffuse peritonitis and open abdomen, researchers from Bulgaria report.

"Despite its advantages, VAC is not a panacea when used alone in severe diffuse peritonitis," Dr. Georgi I. Popivanov from Military Medical Academy in Sofia told Reuters Health by email. "In these cases it should be combined with some of the methods for dynamic fascial closure when the expected duration of open abdomen is over 8-9 days."

Open-abdomen technique is used when there is insufficient control of the primary source of diffuse peritonitis, presence of severe bowel edema, or a need for a second look. How best to manage open abdomen remains unclear.

Dr. Popivanov's team compared two different methods of abdominal wall management -- MFL, developed at their hospital and widely used in other hospitals in Bulgaria, and VAC -- in a prospective trial of 108 patients with diffuse peritonitis.

Patients were allocated to one of these treatments according to surgeon preference, with 49 patients in the VAC group and 59 patients in the MFL group.

Compared with the MFL group, the VAC group had significantly shorter mean ICU (6.1 days vs. 10.6 days for MFL) and hospital (15.1 days vs. 25.9 days for MFL) length of stay despite comparable Mannheim Peritonitis Index (MPI) and APACHE II scores.

VAC was also associated with significantly higher rates of overall (73% vs. 53%) and late (31% vs. 7% for MFL) primary fascial closure, reduced overall mortality (31% versus 53%), and lower rates of necrotizing fasciitis (2% versus 15%), the researchers report in the Journal of the Royal Army Medical Corps, online February 23.

Lower rates of intra-abdominal abscesses and enteroatmospheric fistulas in the VAC group fell short of statistical significance.

"Due to the small sample size and lack of randomization a possible selection bias cannot be excluded," Dr. Popivanov cautioned.

"Another reason we wanted to share our experience is that in the current laparoscopic era probably several surgeons might experience some difficulties in the management of the open abdomen," Dr. Popivanov said. "On one hand, the cases needing this approach are relatively rare. On the other, the patients with an open abdomen are to some extent unattractive and their management requires a full dedication."

Detailed information about the VAC Abdominal Dressing System used in this study may be found at the website of KCI, the manufacturer: http://www.kci-medical.ie/IE-ENG/indications.

The authors declare that they have no competing interests.

SOURCE: http://bit.ly/1Ngvdoh

J R Army Med Corps 2015.