Division of Acute Care Surgery, Department of Surgery, University of Maryland School of Medicine, 22 South Greene Street S10B00, Baltimore, MD, 21201, USA.
Eur J Trauma Emerg Surg. 2019 Aug;45(4):705-711. doi: 10.1007/s00068-018-0968-x. Epub 2018 Jun 9.
The overuse of temporary abdominal closure and second look (SL) laparotomy in emergency general surgery (EGS) cases has been questioned in the recent literature. In an effort to hopefully decrease the number of open abdomen (OA) patients, we hypothesize that reviewing our cases, many of these SL patients could be managed with single-stage operative therapy and thus decrease the number of OA patients.
This is a retrospective review of prospectively collected data from Jun 2013-Jun 2014, evaluating EGS patients managed with an OA who required bowel resection in either index or SL laparotomy. Demographics, clinical variables, complications and mortality were collected. Fisher's exact t test was used for statistical analysis.
During this time frame, 96 patients were managed with OA and 59 patients required a bowel resection. 55 (57%) of those required one bowel resection at the index operation with 4 (4.2%) only requiring one bowel resection at the second operation. In the patients requiring bowel resections, 18 (30%) required a resection at SL. At SL laparotomy, resection was required for questionably viable bowel at the index operation 60% (11), whereas 39% (7) had normal appearing bowel. Indications for resection at SL laparotomy included evolution of existing ischemia, new onset ischemia, staple line revision, and "other". 23 patients (39%) were hemodynamically unstable, contributing to the need for temporary abdominal closure. In the multivariate analysis, preoperative shock was the only predictor of need for further resection. Complications and mortality were similar in both groups.
Almost one-fifth of the patients undergoing SL laparotomy for open abdomen required bowel resections, with 6.8% of those having normal appearing bowel at index operation, therefore in select EGS patients, SL laparotomy is a reasonable strategy.
在最近的文献中，人们对急诊普通外科（EGS）病例中临时腹部关闭和二次探查（SL）的过度使用提出了质疑。为了希望减少开放性腹部（OA）患者的数量，我们假设通过回顾我们的病例，其中许多 SL 患者可以通过单一阶段手术治疗来管理，从而减少 OA 患者的数量。
这是对 2013 年 6 月至 2014 年 6 月期间前瞻性收集数据的回顾性分析，评估了接受 OA 治疗且在指数或 SL 剖腹术中需要肠切除术的 EGS 患者。收集了人口统计学、临床变量、并发症和死亡率。Fisher's 确切检验用于统计分析。
在此期间，96 例患者接受 OA 治疗，59 例患者需要肠切除术。55 例（57%）在指数手术中仅需一次肠切除术，其中 4 例（4.2%）仅在第二次手术中需要一次肠切除术。在需要肠切除术的患者中，18 例（30%）在 SL 时需要进行肠切除术。在 SL 剖腹术中，有 60%（11 例）的患者在指数手术中存在可疑存活的肠管需要切除，而 39%（7 例）的患者肠管外观正常。SL 剖腹术的切除指征包括现有缺血的演变、新出现的缺血、吻合线修正和“其他”。23 例（39%）患者血流动力学不稳定，这导致需要暂时关闭腹部。在多变量分析中，术前休克是需要进一步切除的唯一预测因素。两组的并发症和死亡率相似。
在接受 SL 剖腹术治疗开放性腹部的患者中，近五分之一需要进行肠切除术，其中 6.8%的患者在指数手术时肠管外观正常，因此，在某些 EGS 患者中，SL 剖腹术是一种合理的策略。
