[The «open abdomen» technique for widespread peritonitis].

Area of Science:

• Surgical treatment of peritonitis
• Abdominal trauma and sepsis management

Background:

• Widespread peritonitis treatment often involves laparostomy, also known as the "open abdomen" technique.
• Current methods for laparostomy in peritonitis lack universal acceptance, complicating interpretation of systematic review results due to varied study designs.

Purpose of the Study:

• To analyze modern treatment methods for peritonitis using laparostomy.
• To evaluate the prospects and challenges associated with the "open abdomen" approach.

Main Methods:

• Systematic review of studies on laparostomy for peritonitis.
• Analysis of data considering different methodologies and control group presence.

Main Results:

• Laparostomy presents advantages but also significant risks, including intestinal fistulas, adhesions ("frozen abdomen"), abscesses, delayed wound closure, and ventral hernias.
• The "open abdomen" method is indicated for severe abdominal sepsis, uncontrolled infection, damage control, large abdominal wall defects, significant intestinal paresis, or compartment syndrome.
• The risk of complications like intestinal fistulas increases significantly between 7-12 days post-laparostomy, emphasizing the need for timely wound closure.

Conclusions:

• There is insufficient evidence to definitively favor the "open abdomen" technique over primary closure with on-demand relaparotomy for secondary peritonitis.
• Further research is crucial for developing effective and safe temporary abdominal closure devices and establishing clear indications for the "open abdomen" technique.