Optimization of treatment for diffuse secondary peritonitis using vacuum-assisted abdominal closure technologies
Z. A. Bagatelia,
A. A. Karpov,
D. S. Bocharnikov,
Sh. A. Khusnutdinov,
D. S. Ozerova,
A. V. Mishchenko https://doi.org/10.17238/2072-3180-2025-3-35-41
Abstract
Introduction. Diffuse secondary peritonitis remains a critical surgical challenge due to high mortality (30–60 % in sepsis) and limitations of traditional relaparotomies.
Objective: To improve clinical outcomes in secondary peritonitis using vacuum-assisted abdominal closure technologies.
Materials and methods of research. Included 283 patients with peritonitis (MPI≥20), divided into three groups: planned relaparotomies with passive drainage (group 1, n=145), vacuum-assisted laparostomy (VAL) with 48-hour sanitations (subgroup 2,1, n=81), and vacuum-instillation laparostomy (VIL) with 2,5 % glucose solution (group 3, n=57). Groups were comparable in sex, age, abdominal cavity index, Mannheim Peritonitis Index, and APACHE II score. Outcomes included mortality, Comprehensive Complication Index (CCI), surgical site infections, treatment duration, number of operations, and fascial closure in patients with completed sanitations.
Treatment results. Group 1 had a mortality rate of 35,2 %, CCI of 66,8±34,2, and fascial closure of 73,0 %. Subgroup 2.1 showed reduced mortality (22.2 %, p=0,047), CCI (52,3±30,8, p=0,0013), and fascial closure of 89,6 %. Group 3 achieved the best results: mortality 19,3 % (p=0,018), CCI 44,43±31,4 (p<0,001), and fascial closure 92,2 %. VIL was optimal for severe peritonitis (MPI≥30, mortality 19,6 %, p=0,008).
Conclusion. VAL and VIL outperform relaparotomies, reducing mortality and complications. VIL is optimal for severe peritonitis. The technologies have been implemented.
About the Authors
Z. A. Bagatelia
Botkin Hospital ; Chair of Surgery, Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian Federation, Chair of Surgery
Russian Federation
Russian Federation
Bagatelia Zurab Antonovich – MD, Professor; First Deputy Director
125284, Moscow, 2nd Botkinsky ave., 5
A. A. Karpov
Botkin Hospital ; Chair of Surgery, Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian Federation, Chair of Surgery
Russian Federation
Russian Federation
Karpov Alexey Andreevich – MD, Associate Professor of Surgery; Deputy Chief Physician for Surgery
125284, Moscow, 2nd Botkinsky ave., 5
D. S. Bocharnikov
Botkin Hospital
Russian Federation
Russian Federation
Bocharnikov Dmitry Stepanovich – the head of the surgical department, the surgeon of the Department of Emergency Surgical Care No. 75 of the Center for Emergency and Specialized Care
125284, Moscow, 2nd Botkinsky ave., 5
Sh. A. Khusnutdinov
Botkin Hospital
Russian Federation
Russian Federation
Khusnutdinov Shamil Abdulbarievich – a surgeon at the Department of Emergency Surgical Care No. 75 of the Center for Emergency and Specialized Care
125284, Moscow, 2nd Botkinsky ave., 5
D. S. Ozerova
Botkin Hospital
Russian Federation
Russian Federation
Ozerova Darya Sergeevna – a Candidate of Medical Sciences, a surgeon at the Department of Emergency Surgical Care No. 75 of the Center for Emergency and Specialized Care
125284, Moscow, 2nd Botkinsky ave., 5
A. V. Mishchenko
Educational center of Botkin Hospital
Russian Federation
Russian Federation
Mishchenko Anastasia Viktorovna – a clinical resident
125284, Moscow, 2nd Botkinsky ave., 5
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For citations:
Bagatelia Z.A., Karpov A.A., Bocharnikov D.S., Khusnutdinov Sh.A., Ozerova D.S., Mishchenko A.V. Optimization of treatment for diffuse secondary peritonitis using vacuum-assisted abdominal closure technologies. Moscow Surgical Journal. 2025;(3):35-40. (In Russ.) https://doi.org/10.17238/2072-3180-2025-3-35-41
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