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Management and outcomes of laparostomy in a district general hospital

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Aims:

To investigate the management and outcomes of laparostomy over a 10 year period


Methods:

Cases of laparostomy were collected retrospectively from 2004 to 2014. There were no exclusions. There were a range of general surgeons involved with experience in emergency general surgery.


Results: part 1

22 patients were included. The mean age was 58 years (range 32 to 83). 14 were male.

 

Indication: 11: intra-abdominal sepsis, 9:haemodynamic instability and 2 primary failure

 

13 patients were closed with a Bogota bag, 2 with a sandwich technique, 2 with a renasys suction, 4 with gauze packs and 1 with skin closure only

 

Sepsis group the mean time to closure: 2 days (1 to 4) with a mortality of 10%. The mean post-operative stay was 22 days (7 to 30).2 patients had a deep dehiscence and 1 had a superficial.

 

All were managed conservatively with vacuum dressings. 1 patient following a laparoscopic gastric bypass developed a later fistula which healed spontaneously over 12 months. 6 patients developed an incisional hernia, 1 of whom had a subsequent mesh repair. The rest were managed conservatively.

 

unstable group:mean time to closure was 7 days (2 to 30) with a mortality of 60%. 2:pancreatic necrosis, 2: abdominal trauma and 2: abdominal compartment syndrome following bowel obstruction. The post-operative stay was 26 days (10 to 40). 1 patient developed a superficial dehiscence managed with a vacuum dressing. 2 patients had medical complications which delayed their recovery.


Conclusions:

Laparostomy has better outcomes for intra-abdominal sepsis than haemodynamic instability. Early closure is desirable with reduced post-operative stay and complications. Closed methods of laparostomy are favoured but outcomes are primarily driven by underlying pathology

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