Negative Pressure Therapy with Intraperitoneal Saline Instillation in the Open Septic Abdomen

Introduction: Open abdomen has become a common technique in the management of abdominal sepsis. We present a series of cases of 12 open septic abdomen treated by using intermittent therapy with intra-abdominal irrigation with a modified VAC- Ulta® associated with ABThera® dressing, comparing with ABThera® dressing suction therapy alone. Methods: Pilot prospective study of 12 consecutive patients with temporary abdominal closure for abdominal sepsis. During the initial laparotomy washing of the peritoneal cavity was performed with warm saline. Six patients (Goup 1) were treated by KCI ABThera® dressing, and keeping constant suction pressure -125 mmHg. For the second group (Group 2) the mentioned dressing was used, and we performed also intermittent intra-abdominal instillation with modified VAC-Ulta®. Results: Primary fascial closure was achieved in 100% of patients with instillation therapy, 4 of them in the first change after 3 days, and the other 2 patients in the second change (6th day). In the group 1, only 3 of them were closed (at 3th, 6th and 11th day). Two of them remained with the open abdomen and the other one died. In patients with instillation therapy, there were no intra-abdominal complications after closure. Conclusions: The results obtained by combining the intra-abdominal instillation therapy with suction seem to be promising, regarding the rate of abdominal closure, reducing the time to primary fascial closure and consequently in fewer complications associated with open abdomen.