Subnormothermic oxygenated peritoneal perfusion combined with vacuum-assisted laparostomy for generalized secondary peritonitis: rationale and experimental evaluation

Introduction. Vacuum instillation therapy is used as part of staged surgical treatment of generalized secondary peritonitis and provides active evacuation of peritoneal exudate, abdominal cavity lavage, and decompression. However, its principal effects are aimed primarily at local control of intra – abdominal infection and do not provide targeted correction of impaired tissue perfusion and oxygenation associated with abdominal sepsis. This provided the rationale for developing a method of subnormothermic oxygenated peritoneal perfusion combined with vacuum-assisted laparostomy (SOPP-VAL).
Objective. To develop a method of subnormothermic oxygenated peritoneal perfusion combined with vacuum-assisted laparostomy, experimentally assess its safety and technical feasibility, and compare laboratory, microbiological, and morphological parameters with those obtained using vacuum instillation therapy in a model of generalized peritonitis.
Materials and methods. A controlled experimental study was performed in 10 laboratory animals – minipigs with experimentally induced generalized peritonitis. The animals were allocated into two parallel groups of five animals each: vacuum instillation therapy (VIT) was used in the comparison group, whereas SOPP – VAL was applied in the intervention group. The primary endpoints were the technical feasibility of the SOPP-VAL protocol and the safety of its application. Secondary endpoints included changes in C – reactive protein (CRP) and procalcitonin (PCT) levels, bacterial contamination of peritoneal exudate with a threshold value of ≥10⁴ CFU/mL, and morphological changes in the parietal peritoneum. The experiment and reporting of its results were performed in accordance with the ARRIVE 2.0 guidelines.
Results and discussion. The SOPP-VAL protocol was technically completed in all animals in the intervention group. No registered adverse events associated with the method were observed during the 72-h follow-up period. SOPP-VAL was associated with a more pronounced decrease in mean CRP and PCT levels compared with VIT. Clinically significant bacterial contamination of peritoneal exudate ≥10⁴ CFU/mL, detected at 24 h in all animals in both groups, was absent at 72-h in all animals in the SOPP-VAL group (0/5), whereas it persisted in 3 of 4 animals in the VIT group (75 %); the between – group difference was statistically significant (Fisher’s exact test, p=0,048). Morphological examination in the SOPP-VAL group demonstrated predominantly preserved architecture of the mesothelial layer, less pronounced interstitial edema, microvascular congestion, and inflammatory cell infiltration, while perivascular hemorrhages were virtually absent.
Conclusion. In an experimental model of generalized secondary peritonitis complicated by abdominal sepsis, SOPP-VAL demonstrated technical feasibility and the absence of registered adverse events during the 72-h follow – up period. Compared with vacuum instillation therapy, SOPP-VAL was associated with a more pronounced decrease in mean CRP and PCT levels, a statistically significantly lower frequency of persistent clinically significant bacterial contamination of peritoneal exudate at 72-h, and less pronounced inflammatory and destructive changes in the parietal peritoneum. The obtained results provide a rationale for further clinical evaluation of the efficacy and safety of SOPP-VAL in generalized secondary peritonitis.

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