[Open abdomen as a method of source control in peritonitis: indications and risks]

To compare the results of staged surgical treatment of patients with disseminated secondary peritonitis and to clarify the indications for open abdomen technique.

We analyzed treatment outcomes in 978 patients with disseminated peritonitis. The main causes of peritonitis were destructive appendicitis (430 patients, 43.9%) and gastroduodenal ulcer perforation (217 patients, 22.2%).

Staged debridement in patients with high risk of death (WSES SSS score ≥ 9) significantly reduces in mortality in this group of patients (from 82.5% with traditional tactics to 62.1%). Staged debridement in patients with lower probability of death (WSES SSS score 7-8) does not significantly affect the outcomes. Open abdomen method significantly reduces mortality in patients with abdominal sepsis and septic shock compared to primary suturing and elective re-laparotomy from 75% to 35.3%. Open abdomen method in patients with intra-abdominal pressure >20 mmHg is associated with significantly lower mortality compared to primary suturing (traditional technique) and elective re-laparotomy. VAC systems significantly reduce mortality in patients with WSES SSS score ≥7 compared to anterior abdominal wall closure with local tissues during elective re-laparotomy. The benefit of VAC systems for milder manifestations of peritonitis is not significant.

Indications for open abdomen technique include intraabdominal pressure >20 mmHg or abdominal compartment syndrome. This method prevents tissue ischemia, formation of purulent pockets and, consequently, progression of peritonitis in postoperative period. Open abdomen technique is advisable if hemodynamic instability makes surgery impossible.