Comparison of the Effectiveness of the Treatment Using Standard Methods and Negative Pressure Wound Therapy (NPWT) in Patients Treated with Open Abdomen Technique

• Authors: Krzysztof Szmyt , Łukasz Krokowicz , Adam Bobkiewicz , Bartosz Cybułka , Witold Ledwosiński , Maciej Gordon , Ahmed Alammari , Tomasz Banasiewicz , Michał Drews
• Languages of publication: EN

Abstracts

EN

Open abdomen technique is a surgical treatment in which the fascia and skin are left open in order to reduce the value of the intra-abdominal pressure. According to the World Society of the Abdominal Compartment Syndrome (WSACS) normal values of the intra-abdominal pressure are between 5 and 7 mm Hg. Intra-abdominal hypertension occurs when the pressure value is equal to or exceeds 12 mm Hg.The aim of the study was to compare the results of the open abdomen treatment using standard methods and negative pressure wound therapy.Material and methods. The study was in the form of a retrospective analysis of the documentation of the patients treated with open abdomen technique. The study included 37 patients treated in the Department of General and Endocrine Surgery and Gastroenterological Oncology and in the Department of Anesthesiology and Intensive Care of the Medical Sciences since 2009-2012. Patients were divided into two groups: group 1 (n = 20) was treated with standard surgical procedures (laparostomy, repeated peritoneal cavity lavage) and group 2 (n =17) was treated using negative pressure wound therapy (NPWT). The analysed clinical data included the period of hospitalization and clinical outcome (survival vs death), the occurrence of enteroatmospheric fistulae, cyclical determination of the quantitative C-reactive protein levels.Results. The number of deaths during hospitalization in the group treated with NPWT was lower than in the group treated with standard methods (3 vs 9). The number of fistulae during hospitalization in the group treated with NPWT dropped as compared to the group treated using standard procedures (18% vs 70%). The decrease in the CRP levels was recorded in the group treated with NPWT and its increase - in the group treated with standard methods. Conclusions. The use of NPWT in patients requiring open abdomen treatment is reasonable due to the positive results with respect to survival rates and the decrease in the number of gastrointestinal fistulae. It is necessary to train the physicians in using this type of therapy in the form of workshops and in the clinical setting.

Keywords

EN

C-reactive protein; negative pressure wound therapy; open abdomen

• Journal: Polish Journal of Surgery
• Year: 2015
• Volume: 87
• Issue: 1
• Pages: 22-30

Dates

online

1 - 3 - 2015

received

17 - 7 - 2014

Contributors

author

Krzysztof Szmyt

• Department of General and Endocrine Surgery and Gastroenterological Oncology, Poznań University of Medical Sciences Kierownik: prof. dr hab. M. Drews,

author

Łukasz Krokowicz

• Department of General and Endocrine Surgery and Gastroenterological Oncology, Poznań University of Medical Sciences Kierownik: prof. dr hab. M. Drews

author

Adam Bobkiewicz

• Department of General and Endocrine Surgery and Gastroenterological Oncology, Poznań University of Medical Sciences Kierownik: prof. dr hab. M. Drews

author

Bartosz Cybułka

• Department of Surgery, Independent Public Healthcare Institution, Grodzisk Wielkopolski Ordynator: lek. A. Wach

author

Witold Ledwosiński

• Department of Surgery, Independent Public Healthcare Institution, Grodzisk Wielkopolski Ordynator: lek. A. Wach

author

Maciej Gordon

• Department of Anesthesiology and Intensive Care, Poznań University of Medical Sciences Kierownik: prof. dr hab. L. Drobnik

author

Ahmed Alammari

• Department of Anesthesiology and Intensive Care, Poznań University of Medical Sciences Kierownik: prof. dr hab. L. Drobnik

author

Tomasz Banasiewicz

• Department of General and Endocrine Surgery and Gastroenterological Oncology, Poznań University of Medical Sciences Kierownik: prof. dr hab. M. Drews

author

Michał Drews

• Department of Surgery, Independent Public Healthcare Institution, Grodzisk Wielkopolski Ordynator: lek. A. Wach

References

• 1. Ogilvie WH: The late complications of abdominal war wounds. Lancet 1940; 2: 253-56.
• 2. Adams CA, Biffl WL, Cioffi WG: Surgical Critical Care, in Sabiston Textbook of Surgery, Townsend CM, et al., Editors. Elsevier; Philadelphia 2008;619.
• 3. Diaz JJ, Cullinane DC, Dutton WD et al.: The management of the open ab̚domen in trauma and emergency general surgery: part 1-damage control. J Trauma 2010; 68(6): 1425-38.
• 4. Sugrue M, Buhkari Y: Intra-abdominal pressure and abdominal compartment syndrome in acute general surgery. World J Surg 2009; 33(6): 1123-27.[PubMed][Crossref][WoS]
• 5. Cheatham ML, Malbrain ML, Kirkpatrick A et al.: Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Int Care Med 2007; 33: 951.
• 6. Terzi C, Egeli T, Canda AE, Arslan NC: Management of enteroatmospheric fistulae. Int Wound J 2014; 11 (Suppl 1): 17-21.[WoS]
• 7. Ren J, Yuan Y, Zhao Y et al.: Open abdomen treatment for septic patients with gastrointestinal fistula: from fistula control to definitive closure. Am Surg 2014; 80(4): 339-47.
• 8. Hutan JM, Hutan MS, Skultety J et al.: Use of intraabdominal VAC (Vacuum Assisted Closure) lowers mortality and morbidity in patients with open abdomen. Bratisl Lek Listy 2013; 114(8): 451-54.
• 9. Ozer MT, Sinan H, Zeybek N, Peker Y: A simple novel technique for enteroatmospheric fistulae: silicone fistula plug. Int Wound J 2014; 11 (Suppl1): 22-24.[WoS]
• 10. Hutan M, Banasiewicz T, Veverkova L et al.: Use of Negative Pressure Wound Therapy in Treatment of Enteroatmospheric Fistulas: Critical Review of the Literature. NPWT 2014; 1(1):10-16.
• 11. Bobkiewicz A, Banasiewicz T, Paszkowski J, Drews M: Biliary- Cutaneous and Entero-Cutaneous Fistulas Associated with Extensive Abdominal Wound Following Blunt Abdominal Trauma Treated with Negative Pressure Wound Therapy (NPWT). NPWT 2014; 1(1):22-26; www.researchpub. org/journal/npwt/npwt.html
• 12. Jannasch O, Lippert H, Tautenhahn J: A novel device for treating enteroatmospheric fistulae in the open abdomen. Zentralbl Chir 2011 Dec; 136(6):585-89.[WoS]
• 13. Hougaard HT, Ellebaek M, Holst UT, Qvist N: The open abdomen: temporary closure with a modified negative pressure therapy technique. Int Wound J 2014; 11 (Suppl 1): 13-16.
• 14. W ild T, Staettner S, Lechner P et al.: Experience with Negative Pressure Therapy in Temporary Abdominal Closure of Patients with Secondary Peritonitis. NPWT 2014; 1(2): 33-38; www.researchpub.org/journal/npwt/npwt.html.
• 15. Banasiewicz T, Cybuł1;ka B, Iqbal A et al.: Clinical and Economic Benefit of Negative Pressure Wound Therapy in Treatment of the Open Abdomen. NPWT 2014; 1(2): 39-47; www.researchpub.org/journal/npwt/npwt.html.
• 16. C ambau E: C-reactive protein: general review and role in the study of infections. Pathol Biol(Paris) 1988; 36(10): 1232-36.
• 17. Hallan S, Asberg A: The accuracy of C-reactive protein in diagnosing acute appendicitis a metaanalysis. Scand J Clin Lab Invest 1997; 57(5):373-80.[Crossref]
• 18. de Wit NJ, Berger MY, Vogelenzang R et al.: Summary of the Dutch College of General Practitioners (NHG) practice guideline on 'Diverticulitis'. Ned Tijdschr Geneeskd 2012; 156(5): A4140.
• 19. van Esch S, Krediet RT, Struijk DG: Prognostic factors for peritonitis outcome. Contrib Nephrol 2012; 178: 264-70.
• 20. Vaughan-Shaw PG, Rees JR, King AT: Neutrophil lymphocyte ratio in outcome prediction after emergency abdominal surgery in the elderly. Int J Surg 2012; 10(3): 157-62.[Crossref][WoS]
• 21. Banasiewicz T, Drews M: Negative Pressure Wound Therapy (NPWT) in Open Abdomen - An Animal Model for Surgeons Training. NPWT 2014;1(2): 48-53; www.researchpub.org/journal/npwt/npwt.html.

Identifiers

DOI

10.1515/pjs-2015-0013