Speakers - CIRWC 2024

Abstract

Acute peritonitis is a relatively common intra-abdominal infection that a general surgeon will have to manage many times in his surgical carrier. Usually, it is secondary peritonitis caused by direct peritoneal invasion from inflamed infected viscera or gastrointestinal tract integrity loss. The mainstay of treatment is source control of the infection, which is, in most cases, surgical. In the physiologically deranged patient, there is an indication for source control surgery in order to restore the patient’s physiology and not the patient's anatomy by utilizing a step approach and allowing the patient to resuscitate in the intensive care unit. In such cases, there is a clear indication for relaparotomy; the most common strategy applied is the open abdomen. The fascial edges are not approximated in the open abdomen technique, and a temporary closure technique is used. In such cases, negative pressure wound therapy seems to be the most favorable technique, especially in combination with fascial traction either by sutures or by mesh gives the best results regarding delayed definite fascial closure and morbidity and mortality. In our surgical practice, we utilize, in most cases, the use of negative pressure wound therapy with temporary mesh placement. In the initial laparotomy, the mesh is placed to approximate the fascial edges as much as possible without whoever causing abdominal hypertension, and in every relaparotomy, the mesh is divided in the middle and, after the end of the relaparotomy and dressing change, is approximated as much as possible in order for the fascial edges to be further approximated. In every relaparotomy, the mesh is further reduced to finally allow definite closure of the aponeurosis. In the presence of ostomies, the negative pressure wound therapy can be applied, as usual, taking care to place the dressing around the stoma, and the negative pressure can be the standard of -125 mmHg. However, in the presence of anastomosis, the available data are scarce, and the possible strategies are to differ the anastomosis for the relaparotomy with definitive closure and no further need of negative pressure wound therapy, to lower the pressure to -25 mmHg in order to protect the anastomosis and to place the anastomosis with omentum in order to avoid direct contact to the dressing. The objective should be early closure, within 7 days, of the open abdomen to reduce mortality and complications.