DOI: http://dx.doi.org/10.18203/2349-2902.isj20205893

Primary abdomen closure (using sheath relaxation) versus staged closure (using modified Bogota) following laparotomy in secondary peritonitis: a comparative study

Anupam Das, Ajay Kumar Singh

Abstract


Background: Primary closure or open laparostomy after laparotomy for peritonitis have their own morbidities. In this study, rectus sheath relaxation was used as an alternative to conventional primary closure and compared to the modified Bogota technique in patients of peritonitis.

Methods: We included 60 patients of peritonitis with two of the following criteria: APACHE II score 10-20, Mannheim peritonitis index (MPI) 20-30 or post-resuscitation intraabdominal pressure (IAP) >15 mmHg and randomized them to group A (Sheath relaxation technique) and group B (modified Bogota). Outcome criteria studied included procedure failure, complications, pain, mortality and duration of ICU and hospital stay.

Results: Both groups were comparable in terms of age, gender, inclusion criteria, ICU stay and mortality. The success rate in group A was 63.33% while in group B, was 53.33% with complication rates of 37% and 46.67% respectively. The pain and duration of hospital stay were significantly less in group A.

Conclusions: We concluded that primary abdomen closure using rectus sheath relaxation in select patients was an easy, feasible and better alternative than the staged closure using modified Bogota technique following laparotomy in patients of severe secondary peritonitis. Patients with higher APACHE II and MPI scores may be better managed primarily by modified Bogota technique, while those with lower APACHE II and MPI do well with primary closure with sheath relaxation. The pre- operative APACHE II, MPI and post resuscitation IAP either individually or in combination, could, therefore, predict the wound failure rates, choice of closure techniques.


Keywords


Bogota, Peritonitis, Sheath relaxation

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References


Jenkins TP. The burst abdominal wound: a mechanical approach. Br J Surg. 1976;63(11):873-6.

Hong JJ, Cohn SM, Perez JM, Dolich MO, Brown M, McKenney MG. Prospective study of the incidence and outcome of intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg. 2002;89(5):591-6.

Schein M. Surgical management of intra-abdominal infection: is there any evidence? Langenbecks Arch Surg. 2002;387(1):1-7.

Basu A. A Low-Cost Technique for Measuring the Intra-Abdominal Pressure in Non-Industrialised Countries. Ann R Coll Surg Engl. 2007;89(4):434-5.

Khan S, Verma AK, Ahmad SM, Ahmad R. Analyzing intra-abdominal pressures and outcomes in patients undergoing emergency laparotomy. J Emerg Trauma Shock. 2010;3(4):318-25.

Bohnen JM, Mustard RA, Oxholm SE, Schouten BD. APACHE II score and abdominal sepsis. A prospective study. Arch Surg. 1988;123(2):225-9.

Ukwenya AY, Muhammad I, Nmadu PT. Assessing the severity of intraabdominal Infections; the value of APACHE II Scoring System. Nigerian J Surg Res. 2006;8(1).

Bosscha K, Reijnders K, Hulstaert PF, Algra A, van der Werken C. Prognostic scoring systems to predict outcome in peritonitis and intra-abdominal sepsis. Br J Surg. 1997;84(11):1532-4.

Sharma L, Gupta S, Soin AS, Sikora S, Kapoor V. Generalized peritonitis in India- the tropical spectrum. Jpn J Surg. 1991;21(3):272-7.

Gupta S, Kaushik R. Peritonitis- the Eastern experience. World J Emerg Surg. 2006;1:13.

Gulzar JS, Paruthy SB, Arya SV. Improving outcome in perforated peptic ulcer emergency surgery by Boey scoring. Int Surg J. 2016;3(4):2120-8.

Marwah S, Marwah N, Singh M, Kapoor A, Karwasra RK. Addition of rectus sheath relaxation incisions to emergency midline laparotomy for peritonitis to prevent fascial dehiscence. World J Surg. 2005;29(2):235-9.

Adesunkanmi AR, Ajao OG. The prognostic factors in typhoid ileal perforation: a prospective study of 50 patients. J R Coll Surg Edinb. 1997;42(6):395-9.

Jonsson K, Jensen JA, Goodson WH, Scheuenstuhl H, West J, Hopf HW, et al. Tissue oxygenation, anemia, and perfusion in relation to wound healing in surgical patients. Ann Surg. 1991;214(5):605-13.

Gosain A, Chang N, Mathes S, Hunt TK, Vasconez L. A study of the relationship between blood flow and bacterial inoculation in musculocutaneous and fasciocutaneous flaps. Plast Reconstr Surg. 1990;86(6):1152-623.

García Iñiguez JA, Orozco CF, Muciño Hernández MI, Ortega AL, Trabaldo SS, Cortés Flores AO, et al. Complications of the management of secondary peritonitis with contained-open abdomen. Comparison of the Bogota’s bag versus polypropylene mesh. Rev Gastroenterol Mex. 2004;69(3):147-55.

Adesunkanmi AR, Ajao OG. Typhoid ileal perforation: the value of delayed primary closure of abdominal wounds. Afr J Med Med Sci. 1996;25(4):311-5.

van Hensbroek BP, Wind J, Dijkgraaf MGW, Busch ORC, Goslings JC. Temporary closure of the open abdomen: a systematic review on delayed primary fascial closure in patients with an open abdomen. World J Surg. 2009;33(2):199-207.

Anderson O, Putnis A, Bhardwaj R, Ho-Asjoe M, Carapeti E, Williams AB, et al. Short- and long-term outcome of laparostomy following intra-abdominal sepsis. Colorect Dis. 2011;13(2):e20-32.