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. 2009 Nov;91(8):681-7.
doi: 10.1308/003588409X12486167520993. Epub 2009 Sep 25.

Initial experience of laparostomy with immediate vacuum therapy in patients with severe peritonitis

James Horwood  1 , Fayaz Akbar, Andrew Maw
Affiliations

Initial experience of laparostomy with immediate vacuum therapy in patients with severe peritonitis

James Horwood et al. Ann R Coll Surg Engl. 2009 Nov.

Abstract

Introduction: To report our initial experience of laparostomy and immediate intra-abdominal vacuum therapy in patients with severe peritonitis due to intra-abdominal catastrophes.

Patients and methods: Twenty-seven patients underwent emergency laparotomy and laparostomy formation with the application of immediate intra-abdominal TRAC-VAC therapy (male:female ratio, 1:1.2; median age, 73 years; range, 34-84 years). Predicted mortality was assessed using the P-POSSUM score and compared with clinically observed outcomes.

Results: Ten patients (37%) with a mean predicted P-POSSUM mortality of 72%, died of sepsis and multi-organ failure. Seventeen patients (mean P-POSSUM 48% expected mortality) survived to discharge. One patient with pancreatitis died from small bowel obstruction 1-year post discharge, two patients developed a small bowel fistula. One patient had an allergic reaction to the VAC dressing. Our patients, treated with laparostomy and TRAC VAC therapy, had a significantly improved observed survival when compared to P-POSSUM expected survival (P = 0.004).

Conclusions: Laparostomy with immediate intraperitoneal VAC therapy is a robust and effective system to manage patients with intra-abdominal catastrophes. There were significantly improved outcomes compared to the mortality predicted by P-POSSUM scores. Damage control surgery with laparostomy formation and intra-abdominal VAC therapy should be considered in patients with severe peritonitis.

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Figures

Figure 1
Figure 1
Observed versus predicted cumulative mortality.
See this image and copyright information in PMC

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