Role of open laparostomy in severe abdominal sepsis and other acute abdominal conditions

Abstract

Introduction: Laparostomy or open abdomen is defined as intentionally leaving the abdomen open following laparotomy and closed once condition of the patient becomes stable. The exposed abdominal contents are protected with a temporary cover. This is performed in severely where repeat access to the peritoneal cavity is needed in the postoperative period. This allows free drainage from the peritoneal cavity and prevents the development of complications due to immediate closure of abdomen, such as abdominal compartment syndrome. However, this is a morbid procedure and is associated with many complications. Materials and Methods: In this retrospective study, a total of 25 patients were included. Data were obtained from case records from the emergency and elective surgical departments of patients who had laparostomy in the last 3 years. Analysis of data was done with regard to indications, surgical procedure, timing of return to theatre, fascial closure, and complications including death. Results: In all cases, temporary abdominal closure (TAC) done using a plastic cover or silo bag. Out of 25 patients, 10 patients had gross peritoneal contamination due to gastrointestinal perforation, pancreatic necrosis in 2 cases, bowel gangrene in 2 cases, and abdominal trauma with intraperitoneal bleeding in 3 cases. Two patients died within 48 h of initial surgery. Fascial closure was achieved between 3 and 7 days, with an average of 3.8 days. Only skin closure without fascial closure was performed in 3 cases. Conclusions: Laparostomy is a very useful procedure in severely ill and unstable patients with multiple intra-abdominal injuries, gross peritoneal contamination, and severe bowel edema, where repeat access to the peritoneal cavity is required in the postoperative period. Fascial closure rates are similar to other TAC closure techniques. Wound infections and inability to close fascia are important complications.