Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis
Edivaldo Massazo Utiyama1, Adriano Ribeiro Meyer Pflug2, Sérgio Henrique Bastos Damous2
1Surgery Department, Medical School, Universidade de São Paulo, São Paulo, Brazil.
Objective:
to present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis.
Methods:
we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years); 11 patients were male, and four were female.
Results:
forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision.
Conclusion:
the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.
Insights
Scheduled reoperations using a zipper mesh technique effectively managed severe intra-abdominal sepsis in 15 patients. This approach facilitated wound care and closure, with a 26.6% mortality rate and no resulting fistulas.
Area of Science:
- Surgical Innovation
- Abdominal Surgery
- Critical Care Medicine
Background:
- Intra-abdominal sepsis presents significant management challenges, often requiring multiple surgical interventions.
- Temporary abdominal closure techniques are crucial for managing severe peritonitis and facilitating subsequent procedures.
Purpose of the Study:
- To evaluate the efficacy and safety of scheduled reoperations using a novel zipper mesh technique for temporary abdominal closure in patients with intra-abdominal sepsis.
Main Methods:
- A cohort of 15 patients with intra-abdominal sepsis underwent scheduled reoperations.
- A zipper mesh device was utilized for temporary abdominal closure, allowing for repeated debridement and lavage.
- Reoperations were performed at an average interval of 84 hours under general anesthesia.
Main Results:
- The zipper mesh technique facilitated effective management of severe septic peritonitis, with an average of 3.2 reoperations per patient.
- The device was in place for an average of 13 days, and no fistulas were observed.
- Mortality was 26.6%, and two patients developed hernias post-procedure.
Conclusions:
- Planned reoperations with the zipper mesh combination offer a rapid, simple, and well-tolerated method for managing severe intra-abdominal sepsis.
- This technique allows for effective abdominal lavage, debridement, and facilitates wound care and closure.
