Open abdomen management results. Our experience.
DOI:
https://doi.org/10.18004/Keywords:
Open abdomen, Technique, Abdominal sepsis, ParaguayAbstract
Introduction: The open abdomen is a technique that, consist in deferring the closure of the abdominal cavity after laparotomy, as an alternative management in cases of abdominal sepsis, whose objectives are to prevent the formation of multiple septic foci and protect the abdominal wall, thereby decreasing the damage that happens by successive closures. Objective: To describe the management of open abdomen contained by the Borráez bag at the Second Chair of Surgical Clinic. Material and methods: An observational, descriptive and longitudinal study in patients that went under surgery and were managed with open abdomen contained by the Borráez bag at the Second Chair of Surgical Clinic, from February 2005 to December 2010. Results: 25 patients underwent this surgical technique of contained-open abdomen, of which 13 patients (52%) were female and 12 patients (48%) were male. The average age was 51 years (20 to 81 years) and the open abdomen indications was, fecal peritonitis in 20 patients, intestinal obstruction in 3 patients, Type III evisceration and abdominal wall fasciitis in one patient. Known Pathologies were seen in 41.17% as Rheumatoid Arthritis, Chronic Lymphocytic Leukemia, Diabetes Mellitus and hypertension. The multidisciplinary treatment of open abdomen with the Borráez bag was used throughout the study population, and in 4 of them, concurrently to vacuum aspiration system. The abdominal lavage and bag changing in surgery room were performed every 48 hours. Abdominal lavages were performed 1.8 times in average. Wide spectrum Antibiotics were used as well as enteral nutrition in 8 patients (32%) and parenteral nutrition in 17 (68%). The average length of hospitalization was 48 days (2 to 94 days) and 10 patients (40%) were admitted in the intensive care unit. Five patients (20%) developed intestinal fistulae, and the mortality was 44% (11patients). Conclusion: The contained-open abdomen is an easily reproducible technique of multidisciplinary management with satisfactory results in seriously ill patients of difficult management such as abdominal sepsis.
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