Minimally Invasive Percutaneous Catheter Drainage versus Open Laparotomy with Temporary Closure for Treatment of Abdominal Compartment Syndrome in Patients with Early-stage Severe Acute Pancreatitis

This study aimed to examine the clinical efficacy of minimally invasive percutaneous catheter drainage（PCD） versus open laparotomy with temporary closure in the treatment of abdominal compartment syndrome（ACS） in patients with early-stage severe acute pancreatitis（SAP）. Clinical data of 212 patients who underwent PCD and 61 patients who were given open laparotomy with temporary closure in our hospital over the last 10-year period were retrospectively analyzed, and outcomes were compared, including total and post-decompression intensive care unit（ICU） and hospital stays, physiological data, organ dysfunction, complications, and mortality. The results showed that the organ dysfunction scores were similar between the PCD and open laparotomy groups 72 h after decompression. In the PCD group, 134 of 212（63.2%） patients required postoperative ICU support versus 60 of 61（98.4%） in the open laparotomy group（P〈0.001）. Additionally, 87（41.0%） PCD patients experienced complications as compared to 49 of 61（80.3%） in the open laparotomy group（P〈0.001）. There were 40（18.9%） and 32（52.5%） deaths, respectively, in the PCD and open laparotomy groups（P〈0.001）. In conclusion, minimally invasive PCD is superior to open laparotomy with temporary closure, with fewer complications and deaths occurring in PCD group.

Hypochlorous Acid for Septic Abdominal Processes Using a Unique Negative Pressure Wound Therapy System:A Pilot Study

Background: Septic open abdomens occur in trauma, burn and surgery. Currently, multiple concentrations of hypochlorous acid solutions have effectively decreased the microbiotic burden in wounds. We hypothesized that Vashe?, a neutral hypochlorous acid solution (V-HOCL), would be safe as an intraperitoneal irrigation or washout disinfectant for septic open abdomens utilizing negative pressure wound therapy. Methods: This is a retrospective observational review of patients who required delayed abdominal closures after exploratory laparotomies. Group A (n = 8) had cyclical V-HOCL irrigation to their open abdomens combining AbtheraTM and V.A.C. Dressing System for negative pressure wound therapy with irrigation (NPWT-i) and Group B (n = 9) had intra-abdominal V-HOCL washouts. Results: Fifty percent of both groups had either septic or hemorrhagic shock on admission. Compared to Group B, Group A patients were older (median 50 vs 37 years), and had a median hospitalization of 28 vs 8 days, 4 times as many operations, more acute renal failure and co-morbidities. No statistically significant differences were detected be-tween the two treatment methods with the V-HOCL delivery and removal. Conclusion: There were no episodes of electrolyte imbalance, hypotension, hypertension, anaphylaxis, hemorrhage, visceral injury or systemic toxicity. V-HOCL with/without NPWT-i irrigation was a safe modality and tolerated well in this study.

Reimagining the Visceral Protective Layer with Tailored Manipulation: A Case Report

The visceral protective layer is a standard component of the ABTHERATM systems for temporary abdominal closures. Nonetheless, there are circumstances where the standard, fenestrated visceral protective layer is too large to be successfully applied into every patient’s open abdomen, such as within the abdomen of a child, smaller adult or a patient with previously placed ostomies or drains. The fenestrated, visceral protective layer may require alterations or tailoring for adequate deployment instead of placing the bulk of the visceral protective layer entirely into the open abdomen for temporary abdominal closure. This case report illustrates how the visceral protective layer can be adapted or “reimagined” to conform to a patient with unique or complex abdominal domain features when utilizing the ABTHERATM device prior to facial closure or abdominal wall reconstruction. Photographs are utilized in a step-by-step fashion to aid the clinician in these detailed maneuvers.