Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis

OBJECTIVE: to present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. METHODS: we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years); 11 patients were male, and four were female. RESULTS: forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. CONCLUSION: the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.

【研究目的】总结15例腹腔脓毒症（intra-abdominal sepsis）患者计划性再次手术的临床经验。
【研究方法】本研究采用更为高效的手术技术，即使用带有拉链的尼龙网片（nylon mesh sheet）实施暂时性腹腔关闭（temporary abdominal closure）。所有再次手术均于手术室全身麻醉（general anesthesia）下进行，平均手术间隔时长为84小时。本次手术的清创操作包括清除坏死组织（necrotic material），并对受累腹膜区域（peritoneal area）进行彻底冲洗。本研究纳入患者的平均年龄为38.7岁，年龄范围15~72岁；其中男性11例，女性4例。
【研究结果】40%的感染病因是坏死性胰腺炎（necrotizing pancreatitis）；60%的感染继发于炎症、血管闭塞（vascular occlusion）或创伤导致的肠道脏器（intestinal viscus）穿孔。本研究共实施48次再次手术，平均每位患者接受3.2次手术。网片-拉链装置（mesh-zipper device）平均留置时长为13天。4例患者的拉链旁留置有肠造口（intestinal ostomy），未对患者的临床管理造成不良影响。总体死亡率（mortality）为26.6%，未出现该技术相关的瘘管（fistulas）并发症。当腹腔内病灶得到有效控制后，移除网片-拉链装置并对所有患者实施筋膜（fascia）缝合：其中3例患者采用一期缝合（primary closure）闭合伤口，12例患者采用二期愈合（secondary intent）方式完成伤口闭合。2例患者术后出现疝并发症，其中1例为切口疝（incisional hernia），另1例发生于引流切口处。
【研究结论】通过尼龙网片-拉链组合装置实施计划性再次手术以进行腹腔冲洗与清创，操作快速简便、患者耐受性良好。该技术可有效治疗重症感染性腹膜炎，便于伤口护理，并可实现腹壁的一期闭合。