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5.  Transverse laparostomy is feasible and effective in the treatment of abdominal compartment syndrome in severe acute pancreatitis 
Background
Only recently has the important role of abdominal compartment syndrome (ACS) been recognized as a contributing factor to the multiple organ failure commonly seen in severe acute pancreatitis (SAP). Decompressive laparostomy for ACS is a life-saving procedure usually performed through a midline incision followed by a negative pressure wound dressing. High risk of intestinal fistulas and frequent inability to close the fascia with ensuing planned ventral hernia has prompted the search for alternative techniques. Subcutaneous fasciotomy may be effective in early and less severe cases of ACS but it is always accompanied with a ventral hernia.
Case report
A patient with SAP developed manifest ACS and was treated with bilateral subcostal laparostomy. Immediately after decompression, the intra-abdominal pressure dropped from 23 mmHg to 10 mmHg, and the respiratory, cardiovascular and renal functions improved markedly leading to full recovery. The abdominal incision including the fascia and the skin was closed gradually over 4 relaparotomies, and during the 6 months' follow up there are no signs of ventral hernia or other wound complications.
Discussion
Transverse subcostal laparostomy is a promising alternative decompression technique for ACS in SAP. It is feasible, effective and might provide a chance of early fascial closure. Comparative studies are needed to define its role as a decompressive technique for ACS.
doi:10.1186/1749-7922-3-6
PMCID: PMC2266717  PMID: 18234076
6.  Initial Experience of Laparostomy with Immediate Vacuum Therapy in Patients with Severe Peritonitis 
INTRODUCTION
To report our initial experience of laparostomy and immediate intra-abdominal vacuum therapy in patients with severe peritonitis due to intra-abdominal catastrophes.
PATIENTS AND METHODS
Twenty-seven patients underwent emergency laparotomy and laparostomy formation with the application of immediate intra-abdominal TRAC–VAC® therapy (male:female ratio, 1:1.2; median age, 73 years; range, 34–84 years). Predicted mortality was assessed using the P-POSSUM score and compared with clinically observed outcomes.
RESULTS
Ten patients (37%) with a mean predicted P-POSSUM mortality of 72%, died of sepsis and multi-organ failure. Seventeen patients (mean P-POSSUM 48% expected mortality) survived to discharge. One patient with pancreatitis died from small bowel obstruction 1-year post discharge, two patients developed a small bowel fistula. One patient had an allergic reaction to the VAC dressing. Our patients, treated with laparostomy and TRAC VAC therapy, had a significantly improved observed survival when compared to P-POSSUM expected survival (P = 0.004).
CONCLUSIONS
Laparostomy with immediate intraperitoneal VAC therapy is a robust and effective system to manage patients with intra-abdominal catastrophes. There were significantly improved outcomes compared to the mortality predicted by P-POSSUM scores. Damage control surgery with laparostomy formation and intra-abdominal VAC therapy should be considered in patients with severe peritonitis.
doi:10.1308/003588409X12486167520993
PMCID: PMC2966252  PMID: 19785944
Laparostomy; Intraperitoneal VAC therapy; Damage control surgery; POSSUM
7.  Comparative analysis of primary repair vs resection and anastomosis, with laparostomy, in management of typhoid intestinal perforation: results of a rural hospital in northwestern Benin 
BMC Gastroenterology  2013;13:102.
Background
The objective is to compare primary repair vs intestinal resection in cases of intestinal typhoid perforations. In addition, we hypothesised the usefulness of laparostomy for the early diagnosis and treatment of complications.
Methods
111 patients with acute peritonitis underwent emergency laparotomy: number of perforations, distance of perforations from the ileocaecal valve, and type of surgery performed were recorded. A laparostomy was then created and explored every 48 to 72 hours. The patients were then divided into two groups according to the surgical technique adopted at the initial laparotomy: primary repair (Group A) or intestinal resection with anastomosis (Group B). Clinical data, intraoperative findings, complications and mortality were evaluated and compared for each group.
Results
In 104/111 patients we found intestinal perforations, multiple in 47.1% of patients. 75 had primary repair (Group A) and 26 had intestinal resection with anastomosis (Group B). Group B patients had more perforations than patients in Group A (p = 0.0001). At laparostomy revision, the incidence of anastomotic dehiscence was greater than that of primary repair dehiscence (p = 0.032). The incidence of new perforations was greater in Group B than in Group A (p = 0.01). Group B correlates with a higher morbility and with a higher number of laparostomy revisions than Group A (p = 0.005).
There was no statistical difference in terms of mortality between Group A and Group B. Presence of pus in the abdominal cavity at initial laparotomy correlates with significantly higher mortality (p = 0.0001).
Conclusions
Resection and anastomosis shows greater morbidity than primary repair. Laparostomy revision makes it possible to rapidly identify new perforations and anastomotic or primary repair dehiscences; although this approach may seem aggressive, the number of operations was greater in patients who had a favourable outcome, and does not correlate with mortality.
doi:10.1186/1471-230X-13-102
PMCID: PMC3691877  PMID: 23782915
9.  Laparostomy: why and when? 
Critical Care  2010;14(2):216.
This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855.
doi:10.1186/cc8857
PMCID: PMC2887109  PMID: 20236460
12.  Laparostomy in acute pancreatitis. 
The Ulster Medical Journal  1988;57(2):208-211.
Images
PMCID: PMC2448512  PMID: 3232255
15.  EFFECTS OF ACCESS TO A STIMULATING OBJECT ON INFANT BEHAVIOR DURING TUMMY TIME 
Placing infants in a prone position for “tummy time” often is recommended to ensure appropriate infant development and to combat the effects associated with infants spending extended periods of time in a supine position. However, tummy time may be associated with inappropriate infant behavior such as crying and noncompliance. We provided continuous access to a preferred stimulus to decrease negative vocalizations and to increase the duration of an infant's head being elevated during tummy time.
doi:10.1901/jaba.2012.45-395
PMCID: PMC3405933  PMID: 22844145
crying; noncompliance; infant behavior; stimulating activity; tummy time
16.  “Egyptian Tummy” 
British Medical Journal  1941;1(4197):906-907.
PMCID: PMC2162120
17.  “Egyptian Tummy” 
British Medical Journal  1941;1(4199):988.
PMCID: PMC2161554
18.  “Egyptian Tummy” 
British Medical Journal  1941;1(4181):293-294.
PMCID: PMC2161308
20.  “Egyptian Tummy” 
British Medical Journal  1941;1(4177):137.
PMCID: PMC2160546
21.  “Egyptian Tummy” 
British Medical Journal  1941;1(4175):64.
PMCID: PMC2159997
22.  “Egyptian Tummy” 
British Medical Journal  1941;1(4175):64.
PMCID: PMC2159982
24.  “Egyptian Tummy” 
British Medical Journal  1940;2(4170):806-807.
PMCID: PMC2179996
25.  Letter: Bottle-feeding and tummy-ache in infants. 
British Medical Journal  1976;1(6015):961.
PMCID: PMC1639251  PMID: 946773

Results 1-25 (307681)