Abstract
Introduction: The use of negative pressure dressings for open abdominal therapy has made a great impact on strategies for open abdominal treatment. Observed intestinal damage and developement of fistula formation raises questions about safety of commonly used systems (AB-Thera). The most common used system uses foils for shielding intestines directly from negative pressure. As an alternative a system with open pore dressing in double layer film was introduced (Suprasorb CNP) and proved to safe in animal studies. We compared the effects of this two systems on patients requiring open abdominal treatment.Materials and methods: Patients with secondary peritonitis in at least two abdominal quadrants were included in this randomized study. Inclusion criteria were secondary peritonitis (ACS), abdominal compartment syndrome, and abdominal trauma combined with ACS and/or contaminated abdomen. Patients with active bleeding and pancreatitis were not included. We examined Mannheim peritonitis Index (MPI), bloodcount, PCT, amount of fluid collected, and morphological changes on the bowel. Data were collected on day 2, 4, 7, 14, 21, and 28. Primary end point was fascial closure. Examination was terminated in case of death and damage to the abdominal organs. Groups were compared using Mann Whitney U-test and chi square test. Trend evaluation was evaluated using an one way repeated measure analysis of variance. P-values below 0.05 was considered significat.Results: Thirty four patients were included between August 2010 and September 2012. There were no significant difference between two groups in MPI, age, and gender. Mean duration of treatment, WBC, CRP, and abdominal closure rate were not significantly different between groups. Suprasorb CNP System collected twice more fluid than AB-Thera and decreased PCT on significantly faster rate than AB-Thera. Four patients died (11%) and four patients developed enteric fistula (11%). Closure rate was achieved in 27 out of 34 Patients (79.5%). Closure rate was not significantly different between groups.Conclusion: The use of both systems proved to be efficient and safe. The application of well-dosed, moderate negative pressure on contaminated areas of the abdomen seems to have a lot of potential and it is worth directing greater research potential in this direction.
Highlights
The use of negative pressure dressings for open abdominal therapy has made a great impact on strategies for open abdominal treatment
Negative pressure therapy (NPT) systems offer a new dimension in open abdominal therapy (OAT), fulfilling most of the criteria for optimizing success and minimizing risks in OAT [2]
In a preclinical animal study we have examined this system to determine whether the effect of negative pressure on the surface of the intestine and on organs causes damage [9]
Summary
The use of negative pressure dressings for open abdominal therapy has made a great impact on strategies for open abdominal treatment. The most widespread system, AB-Thera R (ABThera system, KCI, San Antonio, Texas, USA) (Figure 1), and most commercial applications, use soft foils to protect the intestinal bundle, and only sparse openings to keep the negative pressure away from the intestinal surfaces [8]. Opposite to these systems, we use a second film system, Suprasorb-CNP R (Suprasorb CNP system, Lohmann & Rauscher, Austria-Germany) (Figure 1), which protects the intestinal surfaces through soft material properties, but remains permeable to the negative pressure. In a preclinical animal study we have examined this system to determine whether the effect of negative pressure on the surface of the intestine and on organs causes damage [9] This system works with closely spaced pores in a double-layer film. In our in vitro study, this system showed the double drainage effect to the AB-Thera film [10]
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