Open Abdomen and Fluid Instillation in the Septic Abdomen: Results from the IROA Study
Authors: Coccolini Federico , Gubbiotti Francesca , Ceresoli Marco , Tartaglia Dario , Fugazzola Paola , Ansaloni Luca , Sartelli Massimo , Kluger Yoram , Kirkpatrick Andrew , Amico Francesco , Catena Fausto , Chiarugi Massimo ,   the IROA study group, Montori Giulia , Salvetti Fracensco , Negoi Ionut , Zese Monica , Occhionorelli Savino , Shlyapnikov Sergei , Sugrue Michael , Demetrashvili Zaza , Dondossola Daniele , Ioannidis Orestis , Novelli Giuseppe , Nacoti Mirco , Khor Desmond , Inaba Kenji , Demetriades Demetrios , Kaussen Torsten , Jusoh Asri Che , Ghannam Wagih , Sakakushev Boris , Guetta Ohad , Dogjani Agron , Costa Stefano , Singh Sandeep , Damaskos Dimitrios , Isik Arda , Yuan Kuo‐Ching , Trotta Francesco , Rausei Stefano , Martinez‐Perez Aleix , Bellanova Giovanni , Fonseca Vinicius Cordeiro , Hernández Fernando , Marinis Athanasios , Fernandes Wellington , Quiodettis Martha , Bala Miklosh , Vereczkei Andras , Curado Rafael , Fraga Gustavo Pereira , Pereira Bruno M , Gachabayov Mahir , Chagerben Guillermo Perez , Arellano Miguel Leon , Ozyazici Sefa , Costa Gianluca , Tezcaner Tugan , Porta Matteo , Li Yousheng , Karateke Faruk , Manatakis Dimitrios , Mariani Federico , Lora Federico , Sahderov Ivan , Atanasov Boyko , Zegarra Sergio , Fattori Luca , Ivatury Rao , Xiao Jimmy , Ben‐Ishay Offir , Lippi Andrea , Improta Mario , Zharikov Andrey , Dubuisson Vincent 
Published: August 2020

Background

Open abdomen (OA) is a surgical option that can be used in patients with severe peritonitis. Few evidences exist to recommend the use of intraperitoneal fluid instillation associated with OA in managing septic abdomen.

Materials and methods

A prospective analysis of adult patients enrolled in the International Register of Open Abdomen (trial registration: NCT02382770) was performed.

Results

A total of 387 patients were enrolled in two groups: 84 with peritoneal fluid instillation (FI) and 303 without (NFI). The groups were homogeneous for baseline characteristics. Overall complications were 92.9% in FI and 86.3% in NFI (p = 0.106). Complications during OA were 72.6% in FI and 59.9% in NFI (p = 0.034). Complications after definitive closure were 70.8% in FI and 61.1% in NFI (p = 0.133). Entero‐atmospheric fistula was 13.1% in FI and 12% in NFI (p = 0.828). Fascial closure was 78.6% in FI and 63.7% in NFI (p = 0.02). Analysis of FI in negative pressure wound therapy (NPWT) showed: Overall morbidity in NPWT was 94% and in non‐NPWT 91.2% (p = 0.622) and morbidity during OA was 68% and 79.4% (p = 0.25), respectively. Definitive fascial closure in NPWT was 87.8% and 96.8% in non‐NPWT (p = 0.173). Overall mortality was 40% in NPWT and 29.4% in non‐NPWT (p = 0.32) and morality during OA period was 18% and 8.8% (p = 0.238), respectively.

Conclusion

We found intraperitoneal fluid instillation during open abdomen in peritonitic patients to increase the complication rate during the open abdomen period, with no impact on mortality, entero‐atmospheric fistula rate and opening time. Fascial closure rate is increased by instillation. Fluid instillation is feasible even when associated with nonnegative pressure temporary abdominal closure techniques.