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The septic abdomen: open management with Marlex mesh with a zipper
Abstract:
The "open" abdomen has gained popularity in the management of severe intraabdominal sepsis. Drawbacks include evisceration, need for ventilator support, and recurrent abdominal sepsis. We have applied a more aggressive and effective technique consisting of abdominal "closure" with a Marlex mesh sheet containing a zipper. Manual exploration and lavage is performed daily through the zipper in the surgical intensive care unit. Ten patients with severe abdominal sepsis were treated for the following: fecal peritonitis (three patients), radiation enteritis with fistula (one patient), diverticular abscess and dehiscence (one patient), diffuse postoperative abdominal sepsis (two patients), and necrotizing pancreatitis (three patients). Thirteen meshes were inserted, four at first operation and nine at the second to sixth operations. Eight patients survived (80%). Only three patients required respirators; two died. Two patients underwent drainage of three defined abscesses in the surgical intensive care unit. Three patients underwent five major operations through the zipper. Intestinal stomas were present adjacent to the mesh in six patients and were not a management problem. No fistulas resulted from this technique. The Marlex/zipper was removed when all septic signs abated and adhesions were allowed to form (average of 10 to 12 days). Daily aggressive manual lavage of the abdomen through a Marlex mesh/zipper is rapid, simple, and well tolerated. It has permitted effective management of severe septic peritonitis and easier wound care. This technique merits further controlled trials to ascertain its ultimate benefit in survival.
Insights
A novel Marlex mesh/zipper technique for abdominal closure in severe intraabdominal sepsis demonstrated an 80% survival rate. This method allows daily lavage, simplifying wound care and improving patient outcomes in critical surgical cases.
Area of Science:
- Surgical critical care
- Abdominal surgery
- Infectious disease management
Background:
- The open abdomen approach is common for severe intraabdominal sepsis but has drawbacks like evisceration and recurrent sepsis.
- Existing methods present challenges in managing complex abdominal infections and wound complications.
Purpose of the Study:
- To evaluate a novel abdominal closure technique using Marlex mesh with a zipper for severe intraabdominal sepsis.
- To assess the efficacy and safety of daily manual abdominal lavage through the zipper in critically ill patients.
Main Methods:
- Ten patients with severe intraabdominal sepsis underwent abdominal closure with a Marlex mesh/zipper system.
- Daily manual exploration and lavage were performed through the zipper in the surgical intensive care unit.
- The mesh was removed after septic signs abated, allowing adhesions to form.
Main Results:
- An 80% survival rate (8 out of 10 patients) was achieved.
- Only three patients required mechanical ventilation, and no new fistulas developed.
- The technique facilitated easier wound care and allowed for procedures through the zipper, with no management issues with adjacent intestinal stomas.
Conclusions:
- Abdominal closure with a Marlex mesh/zipper enables daily lavage, proving effective and well-tolerated for severe septic peritonitis.
- This technique simplifies wound care and may improve survival rates in complex abdominal sepsis cases.
- Further controlled trials are warranted to confirm the benefits of this innovative surgical approach.