Laparostomy for combat abdominal trauma. criteria for the possibility and optimal timing of laparostomy closure

Introduction. The article is devoted to the analysis of the use of laparostomy in patients with combat abdominal trauma (BAT) and the definition of criteria, timing and methods of its closure. A multifactorial retrospective analysis of the data of 304 patients with laparostomy formed at the stages of medical evacuation revealed that the timing and method of laparostomy closure depend on the initial severity of the injury, the effectiveness of programmatic sanitation and the choice of technology for temporary closure of the abdominal cavity.
Materials and methods. A retrospective multifactorial analysis of the primary medical documentation of a sample of 304 patients hospitalized at the Vishnevsky National Research Medical Center of the Ministry of Defense of the Russian Federation in the period 2022–2024 inclusive with laparostoma formed during surgery for BAT at the stages of medical evacuation was carried out.
The results of the study. When comparing the average severity of the condition of patients in clinical groups 1 and 2 at the time of hospitalization from the stages of medical evacuation to the Vishnevsky National Research Medical Center of the Ministry of Defense of the Russian Federation, significant differences (p < 0,05) in these indicators were revealed for all scales used in the study. The optimal period for primary fascial closure of laparostomy is the period 7–8 days after the initial operation. Control of the source of infection and adequate systemic antibacterial therapy make it possible to complete the open management program by closing the laparostome. Laparostomy closure at a later date is associated with an increased risk of intra-abdominal and wound complications. Primary fascial closure of the laparostome cannot be performed in the presence of intestinal fistula, massive adhesions (Bjork > 2b), extensive abdominal wall defect, intraabdominal hypertension; under these circumstances, laparostome closure is performed by applying skin sutures.
Discussion. The formation of a laparostomy with subsequent abdominal rehabilitation at the stages of medical evacuation is currently a common treatment strategy for patients with BAT. The transformation of criteria for the possibility of completing the program of stage-by-stage rehabilitation and primary fascial closure of laparostomy into surgical tactics algorithms for BAT is the subject of further research.
Conclusion. The conducted study illustrates the fact that the timing and technology of completing the program of staged rehabilitation for laparostomy depend on the initial severity of BAT, the adequacy of intra-abdominal infection control, and the choice of a method for temporary closure of the abdominal cavity.

1. Gostischev V. K., Sazhin V. P., Avdovenko A. L. Peritonitis. M.: Medicine, 1992, 224 p. (In Russ.)

2. Stone H.H., Strom P.R., Mullins R.J. Management of the major coagulopathy with onset during laparotomy. Ann Surg., 1983, № 197(5), рр. 532–535. https://doi.org/10.1097/00000658-198305000-00005

3. Benz D., Balogh Z.J. Damage control surgery: current state and future directions. Curr Opin Crit Care, 2017, Dec; № 23(6), рр. 491–497. https://doi.org/10.1097/MCC.0000000000000465

4. Chung C.Y., Scalea T.M. Damage control surgery: old concepts and new indications. Curr Opin Crit Care, 2023, Dec 1; № 29(6), рр. 666–673. https://doi.org/10.1097/MCC.0000000000001097

5. Guillen B., Cassaro S. Traumatic Open Abdomen. 2023 Jul 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2025, Jan. PMID: 29262207.

6. Kreis B.E., de Mol van Otterloo A.J., Kreis R.W. Open abdomen management: a review of its history and a proposed management algorithm. Med Sci Monit., 2013, Jul 3; № 19, рр. 524–533. https://doi.org/10.12659/MSM.883966

7. Zahid M.J., Hussain M., Kumar D., Hamza M., Zeb Jan S.A., Safdar H., Ajith J.K., Prakarsh I., Awuah W.A. A descriptive analysis of skin-only closure and Bogota bag techniques for achieving complete fascial closure in damage control abdominal surgery. BMC Surg., 2024, Jun 20; № 24(1), рр. 192. https://doi.org/10.1186/s12893-024-02484-2

8. Wittmann D.H., Aprahamian C., Bergstein J.M., Edmiston C.E., Frantzides C.T., Quebbeman E.J., Condon R.E. A burr-like device to facilitate temporary abdominal closure in planned multiple laparotomies. Eur J Surg., 1993, Feb; № 159(2), рр. 75–79.

9. Wang Y., Alnumay A., Paradis T., Beckett A., Fata P., Khwaja K., Razek T., Grushka J., Deckelbaum D.L. Management of Open Abdomen After Trauma Laparotomy: A Comparative Analysis of Dynamic Fascial Traction and Negative Pressure Wound Therapy Systems. World J Surg., 2019, Dec; № 43(12), рр. 3044–3050. https://doi.org/10.1007/s00268-019-05166-w

10. Coccolini F., Montori G., Ceresoli M., Catena F., Ivatury R., Sugrue M., IROA: International Register of Open Abdomen, preliminary results. World J Emerg Surg., 2017, Feb 21; № 12, рр. 10. https://doi.org/10.1186/s13017-017-0123-8

11. Miller R.S., Morris J.A.Jr., Diaz J.J.Jr., Herring M.B., May A.K. Complications after 344 damage-control open celiotomies. J Trauma. 2005, Dec; № 59(6), рр. 1365–1371. https://doi.org/10.1097/01.ta.0000196004.49422.af

12. Serfin J., Dai C., Harris J.R., Smith N. Damage Control Laparotomy and Management of the Open Abdomen. Surg Clin North Am., 2024, № 104(2), рр. 355–366. https://doi.org/10.1016/j.suc.2023.09.008

13. Sharrock A.E., Barker T., Yuen H.M., Rickard R., Tai N. Management and closure of the open abdomen after damage control laparotomy for trauma. A systematic review and meta-analysis. Injury, 2016, № 47(2), рр. 296–306. https://doi.org/10.1016/j.injury.2015.09.008

14. Shabunin A.V., Bedin V.V., Dolidze D.D., Aminov M.Z. The role of vacuum-assisted laparostomy in the treatment of common peritonitis. Surgery, 2024, № 5, рр. 7–13. (In Russ.) https://doi.org/10.17116/surgery 20240517

15. Gelfand B.R., Kiriyenko A.I., Khachatryan N.N. Abdominal surgical infection: Russian national recommendations. M. : MIA, 2018, 168c. (In Russ.)

16. Zavada, N. V. The role of vacuum-assisted laparostomy in the treatment of common peritonitis. Intraabdominal infection. Issues of diagnosis and treatment: Collection of materials of the Republican scientific and practical videoconference with international participation, Minsk, November 20, 2020. Minsk: Belarusian State Medical University, 2020, pp. 58–60. (In Russ.)

17. Chen Y., Ye J., Song W., Chen J., Yuan Y., Ren J. Comparison of Outcomes between Early Fascial Closure and Delayed Abdominal Closure in Patients with Open Abdomen: A Systematic Review and Meta-Analysis. Gastroenterol Res Pract., 2014, рр. 784056. https://doi.org/10.1155/2014/784056

18. Goussous N., Kim B.D., Jenkins D.H., Zielinski M.D. Factors affecting primary fascial closure of the open abdomen in the nontrauma patient. Surgery, 2012, № 152(4), рр. 777–784. https://doi.org/10.1016/j.surg.2012.07.015

19. Vogel T.R., Diaz J.J., Miller R.S. et al. The open abdomen in trauma: do infectious complications affect primary abdominal closure? Surg Infect (Larchmt), 2006, № 7(5), рр. 433–441. https://doi.org/10.1089/sur.2006.7.433

20. Dubose J.J., Scalea T.M., Holcomb J.B. et al. Open abdominal management after damage-control laparotomy for trauma: a prospective observational American Association for the Surgery of Trauma multicenter study [published correction appears in J Trauma Acute Care Surg. 2014 Mar;76(3):902. Erriksson, Evert [corrected to Eriksson, Evert]]. J Trauma Acute Care Surg., 2013, № 74(1), рр. 113–1122. https://doi.org/10.1097/TA.0b013e31827891ce