Fechamento de laparostomia com descolamento cutâneo-adiposo: uma técnica simples e eficaz para um problema complexo

Abstract

To describe a technique of laparotomy closure through cutaneous-adipose tissues detachment and its results. From January 2003 to october 2008 forty patients in laparotomy (Bogota bag) were engaged in surgical procedures for closing their open abdomens according to the technique described here. Data were collected from patient records and during active search. The majority of patients was men (95%) with gunshot wounds (70%). The average ISS and APACHE II scores were 28.78 and 20, respectively. Ventral hernias were found in 81.5% of patients with a mean follow-up time of 9.2 months. Approximately 1/3 of patients had small hernias and didn't want to have their hernias closed because they didn't feel any functional or anatomic impediment to support the closure at that time. Only two patients were dissatisfied in relation to daily activities and to the surgical procedure itself. There were neither deaths nor intestinal fistula with this type of closure. Although it doesn't represent a technique for fascial closure, it is simple to perform, safe, and with low cost. It is a therapeutic option for patients with open abdomen, especially if closure of the aponeurosis was not possible in the first 7 to 10 days.