Ngwelezane General Hospital, South Africa.
Ngwelezane General Hospital, South Africa and Department of Surgery, University of KwaZulu-Natal, South Africa.
S Afr J Surg. 2021 Mar;59(1):20-24.
Acute laparotomy for trauma or sepsis often prevents definitive closure due to need for relook laparotomy or to prevent abdominal compartment syndrome. Skin-only closure is widely used in our setting. In this study, we review the safety and effectiveness of this technique.
Patients presenting with intra-abdominal pathology undergoing acute laparotomy and then subsequent skinonly closure using 2-0 prolene were included in the study and followed postoperatively for a three-month period for adverse events stratified by Clavien-Dindo grading, and rate of definitive closure.
During the study period, twenty-five patients underwent emergent laparotomy and skin-only closure. The median age of patients undergoing skin-only closure was 27 years (standard deviation 9.1). Six patients presented with major trauma and 19 presented with sepsis. Twenty-one patients underwent subsequent fascial closure. One patient was unable to undergo fascial closure and was managed as a planned ventral hernia. Fourteen patients developed a postoperative complication. There were no deaths and no readmissions to intensive care. Three further patients developed a ventral hernia.
Skin-only closure, in carefully selected patients, is a feasible alternative to other temporary abdominal closure techniques in a resource-constrained setting.
创伤或脓毒症的急性剖腹手术常因需要再次剖腹探查或预防腹腔间隔室综合征而无法进行确定性关闭。在我们的环境中，仅皮肤关闭被广泛使用。在这项研究中，我们回顾了该技术的安全性和有效性。
研究纳入了因腹部内病理而接受急性剖腹手术，然后使用 2-0 prolene 进行仅皮肤关闭的患者，并在术后三个月内进行随访，根据 Clavien-Dindo 分级和确定性关闭率对不良事件进行分层。
在研究期间，25 名患者接受了紧急剖腹手术和仅皮肤关闭。接受仅皮肤关闭的患者的中位年龄为 27 岁（标准差 9.1）。6 名患者有重大创伤，19 名患者有脓毒症。21 名患者随后进行了筋膜关闭。1 名患者无法进行筋膜关闭，被作为计划的腹侧疝进行管理。14 名患者发生术后并发症。无死亡和无再入住重症监护病房。另外 3 名患者发生了腹侧疝。
在资源有限的环境中，对于精心挑选的患者，仅皮肤关闭是其他临时腹部关闭技术的可行替代方案。
