Development of a low cost laparostomy technique. Two years experience in the Trauma Center of Cesena, Italy

Abstract

BACKGROUND: In the last few years laparostomy has become an even more useful option for the surgeon due to the development of the experience in the critical abdominal trauma and in the severe surgical urgencies as PANE and peritonitis with the introduction of Damage Control as surgical strategy to prevent the abdominal compartimental syndrom (ACS). After a laparostomy the surgeon needs to provide a delayed fascial closure to achieve the best outcome for the patient. The aim of this paper is to illustrate the experience and the results after the introduction of a modified laparostomy technique in our surgical activity.

METHODS: Protection of intestinal content, aspiration under sub-athmospheric pressure, control in quality and quantity of the drainage and skin temporary closure, rappresent the four principles of the PACS tecnique. In order to evaluate the rate of delayed fascial closure and the rate of ACS onset, we have retrospectively studied 31 patients over a period of 2 years treated with open abdomen with an amount of 36 PACS performed. Routinely IAP measurament was also performed.

RESULTS: ACS was developed in no patients. IAP was measured on average at 19. DFC was achieved in 33 PACS of 36 (91.7%) after 5 days on average (20 hours as minimum; 20 days as maximum). Aspected mortality (SAPSII) in ICU for these patient was 76.5% on average. On 31 patients, 20 (64.5%) died and 11 (35.5%) survived.

CONCLUSION: PACS seems to be an effective, easy and low cost technique for the management of open abdomen