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Abdomineller Vakuumsaugverband beim offenen Abdomen

Abdominal vacuum device with open abdomen

  • Leitthema
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Zusammenfassung

Hintergrund

Das offene Abdomen kann zur Behandlung einer Peritonitis oder eines abdominellen Kompartmentsyndroms erforderlich werden. Aufgrund hiermit nur bedingt zufrieden stellender Ergebnisse wurden verschiedene technische Modifikationen des Verfahrens entwickelt und angewendet. Neuerdings wird als temporärer Bauchdeckenverschluss der abdominelle Vakuumverband zunehmend propagiert. Die hiermit von uns bei einem viszeral-chirurgisch, onkologischen Patientengut gesammelten aktuellen Erfahrungen werden analysiert.

Patienten und Methode

Von 2003–2005 wurden bei 36 Patienten insgesamt 151 abdominelle Zweischichtvakuumverbände angelegt. Indikationen waren eine Peritonitis (n=22), ein abdominelles Kompartmentsyndrom (n=11) und eine nekrotisierende Fasziitis (n=3).

Ergebnisse

Die Behandlungsdauer betrug über alle Gruppen 13 Tage (3–48 Tage). Es traten 4 enterische Fisteln (11%) sowie 4 Bauchdeckenblutungen (11%) auf. 4 Patienten verstarben während und 4 Patienten nach der abdominellen Vakuumtherapie im septischen Multiorganversagen. Ein direkter Faszienverschluss gelang bei insgesamt 26 Patienten (72%). Einen alloplastischen Faszienersatz erhielten 6 Patienten (17%). Bei 2 von 28 Patienten zeigte sich nach einem medianen Follow-up von 100 Tagen eine Narbenhernie und bei 2 weiteren Patienten ein „Narbenknochen“.

Schlussfolgerung

Im Vergleich zu anderen temporären Bauchdeckenverschlüssen sprechen unsere Erfahrungen für eine Überlegenheit des abdominellen Vakuumverbandes bezüglich der klinischen Handhabbarkeit sowie einer relativ niedrigen Rate an behandlungsassoziierten Frühkomplikationen. Auch der meist hiernach mögliche primäre Faszienverschluss, mit einer für die ursprünglich zugrunde liegende Erkrankungssituation akzeptablen Rate an Bauchwandhernien, sind Vorteile des Verfahrens.

Abstract

Background

For the treatment of peritonitis or abdominal compartment syndrome, an open abdomen can be required. Because of the high complication rate associated with this method, different technical modifications were developed that are now being applied. Abdominal vacuum-assisted closure is increasingly favoured. We analyse our experience with this device in a distinct group of patients from gastrointestinal cancer surgery.

Patients and method

From June 2003 to December 2005, 36 patients were treated with 151 double-layer abdominal vacuum devices. Indications for applying this device were peritonitis (n=22), abdominal compartment syndrome (n=11), and necrotising fasciitis (n=3). Thirty-four patients gave anamneses of malignoma.

Results

Overall, the vacuum therapy treatment lasted a median of 13 days (range 3–48). With it, four enteric fistulas (11%) and four abdominal wall bleedings (11%) occurred. In our patient group, no new intra-abdominal abscesses were observed. Four patients died during treatment with the vacuum-assisted device and four afterward because of multiple organ failure in acute sepsis (in-hospital mortality 22%). Twenty-six patients (72%) underwent direct fascial closure after a median treatment duration of 10 days. Six patients (17%) required synthetic mesh for fascial closure. After a median follow-up of 100 days, two patients developed ventral hernias and two others showed ossification of the scar.

Conclusion

Compared with other methods of temporary abdominal closure, our experience with the vacuum-assisted device demonstrates its advantages concerning clinical feasibility and the relatively low complication rate. The high rate of direct fascial closure with an acceptable rate of ventral hernias following vacuum-assisted abdominal closure are further benefits of this technique.

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Authors and Affiliations

  1. Klinik für Chirurgie und Chirurgische Onkologie, Universitätsmedizin Berlin , Charité Campus Buch, Robert-Rössle-Klinik im Helios-Klinikum Berlin, Lindenberger Weg 80, 13125 , Berlin

    P. Oetting, B. Rau &  P. M. Schlag

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  1. P. Oetting
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  2. B. Rau
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  3. P. M. Schlag
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Correspondence to P. M. Schlag.

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Oetting, P., Rau, B. & Schlag, P.M. Abdomineller Vakuumsaugverband beim offenen Abdomen. Chirurg 77, 586–593 (2006). https://doi.org/10.1007/s00104-006-1200-9

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