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5.  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
6.  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
7.  Delayed Primary Closure of the Septic Open Abdomen with a Dynamic Closure System 
World Journal of Surgery  2011;35(10):2348-2355.
Background
The major challenge in the management of patients with an infected open abdomen (OA) is to control septic peritonitis and intra-abdominal fluid secretion, and to facilitate repeated abdominal exploration, while preserving the fascia for delayed primary closure. We here present a novel method for closure of the infected OA, based on continuous dynamic tension, in order to achieve re-approximation of the fascial edges of the abdominal wall.
Methods
Eighteen cases with severe peritonitis of various origin (e.g., gastrointestinal perforations, anastomotic leakage) were primarily stabilized by laparostomy, sealed with either the vacuum-assisted closure abdominal dressing or the Bogotá bag. After hemodynamic stabilization and control of the sepsis, the Abdominal Re-approximation Anchor System (ABRA; Canica Design, Almonte, Ontario, Canada) was applied. This system approximates the wound margins through dynamic traction exerted by transfascial elastomers. Before ABRA application, 5/18 patients had a grade 2B, 2/18 a grade 3, and 11/18 a grade or 4 status according to the open abdomen classification of Björck.
Results
In this severely ill population the mean time before ABRA system application was 12 days (range: 2–39 days). Two of 18 patients died of non-ABRA-related causes within three weeks. In 14 of the remaining 16 patients (88%) primary abdominal closure of the midline was accomplished in 15 days (range: 7–30 days). The other two patients needed a component separation technique according to Ramirez to reach closure. However, secondary wound dehiscence occurred in both these patients. Two thirds of patients (12/18) developed pressure sores to the skin and/or dermis, but all healed without further complications. During outpatient clinic follow-up, 4/14 successfully closed patients still developed a midline hernia.
Conclusions
Delayed primary closure of OA in septic patients could be achieved in 88% with this new approximation system. However, the risk of hernia development remained. We consider this system a useful tool in the treatment of septic patients with an open abdomen.
Electronic supplementary material
The online version of this article (doi:10.1007/s00268-011-1210-8) contains supplementary material, which is available to authorized users.
doi:10.1007/s00268-011-1210-8
PMCID: PMC3170463  PMID: 21850603
9.  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
10.  Safe Tummy Tuck: Anatomy and Strategy to Avoid Injury to the Lateral Femoral Cutaneous Nerve During Abdominoplasty 
Eplasty  2015;15:e22.
Background: Abdominoplasty is one of the most common aesthetic procedures performed in the United States. While poor contour and unsatisfactory cosmetic result have been recognized, neuropathic pain from lateral femoral cutaneous nerve injury has been poorly described. We aim to improve outcomes by using an anatomical study to develop a strategy to avoid injury to the lateral femoral cutaneous nerve in abdominoplasty. Methods: Twenty-three fresh cadaver abdomens were dissected to evaluate the course of the lateral femoral cutaneous nerve, using 2.5× loupe magnification. Measurements were taken from the nerve to the anterior superior iliac spine and from the pubic symphysis to the lateral femoral cutaneous nerve. Recordings of the relationship of the nerve to the inguinal ligament and depth at scarpa's fascia were also made. Statistical analysis was performed to find average distances with a standard deviation. Results: On average, the distance from the lateral femoral cutaneous nerve to the anterior superior iliac spine was 3.62 (SD = 1.32) cm and 13.58 (SD = 2.41) cm from the pubic symphysis in line with the inguinal ligament. The lateral femoral cutaneous nerve was found at the inguinal ligament 80% of the time and 20% of the time superior to the ligament and always deep to scarpa's fascia. Conclusion: Abdominoplasty carries a high patient and surgeon satisfaction rate. The plastic surgeon is continuously challenged to identify ways to improve outcomes, efficiency, and morbidity. Minimal and careful dissection in the area around 4 cm of the anterior superior iliac spine in addition to preserving scarpa's fascia near the inguinal ligament may serve as key strategies to avoiding lateral femoral cutaneous nerve injury.
PMCID: PMC4473816  PMID: 26171094
abdominoplasty; safety; lateral femoral cutaneous nerve; plastic surgery; tummy tuck
11.  “Egyptian Tummy” 
British Medical Journal  1941;1(4197):906-907.
PMCID: PMC2162120
12.  “Egyptian Tummy” 
British Medical Journal  1941;1(4199):988.
PMCID: PMC2161554
13.  “Egyptian Tummy” 
British Medical Journal  1941;1(4181):293-294.
PMCID: PMC2161308
15.  “Egyptian Tummy” 
British Medical Journal  1941;1(4177):137.
PMCID: PMC2160546
16.  “Egyptian Tummy” 
British Medical Journal  1941;1(4175):64.
PMCID: PMC2159997
17.  “Egyptian Tummy” 
British Medical Journal  1941;1(4175):64.
PMCID: PMC2159982
19.  “Egyptian Tummy” 
British Medical Journal  1940;2(4170):806-807.
PMCID: PMC2179996
20.  Letter: Bottle-feeding and tummy-ache in infants. 
British Medical Journal  1976;1(6015):961.
PMCID: PMC1639251  PMID: 946773
21.  Modified Opsite® Sandwich for Temporary Abdominal Closure: A Non-Traumatic Experience 
INTRODUCTION
Laparostomy techniques have advanced since the advent of damage control surgery for the critically injured patient. Numerous methods of temporary abdominal closure (TAC) are described in the literature with most reports focusing on trauma. We describe a modified technique for TAC and report its use in a series of critically ill non-trauma patients.
PATIENTS AND METHODS
Eleven patients under the care of one consultant underwent TAC over a 36-month period. A standardised technique was used in all cases and this is described. Severity of illness at the time of the first laparotomy was assessed using the Portsmouth variant of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM).
RESULTS
Nineteen TACs were performed in 11 patients with a variety of serious surgical conditions. In-hospital mortality was zero despite seven of the patients having an individual P-POSSUM predicted mortality in excess of 50%. The laparostomy dressing proved simple in construction, facilitated nursing care and was well-tolerated in the critical care environment. All patients underwent definitive fascial closure during the index admission.
CONCLUSIONS
Laparostomy is a useful technique outwith the context of trauma. We have demonstrated the utility of the modified Opsite® sandwich vacuum pack for TAC in a series of critically ill patients with a universally favourable outcome. This small study suggests that selective use of TAC may reduce surgical mortality.
doi:10.1308/003588407X155446
PMCID: PMC1963556  PMID: 17316524
Laparostomy; Temporary abdominal closure (TAC); Abdominal compartment syndrome (ACS)
22.  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
23.  Surgical management of abdominal compartment syndrome; indications and techniques 
The indications for surgical decompression of abdominal compartment syndrome (ACS) are not clearly defined, but undoubtedly some patients benefit from it. In patients without recent abdominal incisions, it can be achieved with full-thickness laparostomy (either midline, or transverse subcostal) or through a subcutaneous linea alba fasciotomy. In spite of the improvement in physiological variables and significant decrease in IAP, however, the effects of surgical decompression on organ function and outcome are less clear. Because of the significant morbidity associated with surgical decompression and the management of the ensuing open abdomen, more research is needed to better define the appropriate indications and techniques for surgical intervention.
doi:10.1186/1757-7241-17-17
PMCID: PMC2671476  PMID: 19366442
24.  CASE REPORT An Unusual Case of Abdominal Compartment Syndrome Following Resection of Extensive Posttraumatic Mesenteric Ossification 
Eplasty  2013;13:e13.
Introduction: Heterotopic mesenteric ossification is an extremely rare condition, which often follows trauma and is frequently symptomatic. To date, there are no reports in the literature of abdominal compartment syndrome occurring after surgical resection of mesenteric calcification. The present report documents an unusual case of compartment syndrome complicating resection of extensive mesenteric calcification despite abdominal closure with the components-separation technique. Method: A 48-year-old man undergoing components-separation technique for posttraumatic laparostomy hernia repair (ileostomy reversal and sigmoid stricture correction) was found to have extensive heterotopic mesenteric calcification, which needed resection. Results: Resection of the mesenteric calcification was complicated by intraoperative hemorrhage and unplanned small bowel resection. Later the patient developed secondary hemorrhage leading to an abdominal compartment syndrome, which was successfully treated by decompression, hemostasis, and Permacol-assisted laparotomy wound closure. The patient remains symptom-free more than 2 years after surgery. Discussion: The case herein reported gives an account of the rare occurrence of abdominal compartment syndrome following resection of posttraumatic ectopic mesenteric ossifications. It is highly unusual in that it occurred because of “secondary hemorrhage” and despite abdominal closure with the components-separation technique, which had been undertaken precisely to prevent compartment syndrome with direct closure. It therefore highlights the need for continued clinical vigilance in complex posttraumatic cases.
PMCID: PMC3593338  PMID: 23573333
25.  Damage control surgery by keeping the abdomen open during pregnancy: favorable outcome, a case report 
Background
Acute abdomen in advanced pregnancy is one of the most challenging surgical situations. In life-threatening situations, despite optimal management, foetus distress and preterm delivery may occur. Although laparostomy is a useful treatment of abdominal sepsis, its successful management has not been reported previously in pregnant women.
Case
30-year-old woman at 23 week of pregnancy was investigated for non-specific abdominal pain. Surgical exploration revealed extensive ischemic bowel necrosis. Multiple segmental resections were performed and abdomen was left open with vacuum assisted dressing, maintained for 48 hours. At the third surgical look the continuity was restored and abdominal wall closed. The foetal condition stayed unperturbed under pharmacologic tocolysis. Pregnancy was carried to full term delivery.
Conclusion
Open abdomen strategy can be successfully applied in pregnant woman.
doi:10.1186/1749-7922-4-33
PMCID: PMC2758843  PMID: 19778444

Results 1-25 (342684)