Improvement of Three Duodenal Re-leaks: Two-way Vacuum-assisted Closure.

We share our experience of a two-way vacuum-assisted closure (VAC) technique that allows patients to heal when generalised peritonitis develops because of a recurrent duodenal leak. Two patients underwent omentoplasty for duodenal ulcer perforation and one patient underwent antrectomy, gastrojejunostomy, and tube duodenostomy. Two-way VAC was performed by taking an abdominal fluid culture and washing the abdomen with 6-12 litres of warm saline. Two-way VAC exchange pro-cedures were continued every 3 days and total parenteral nutrition was administered until cessation of the duodenal re-leak. The two-way VAC application was terminated when improvement in the re-leak was macroscopically detected. The subcutaneous layer was dissected from the anterior abdominal wall fascial layer, and the abdominal skin was closed without tension. The patients were subsequently discharged. Controlling the primary source is often difficult when treating duodenal re-leaks, and two-way VAC can localise the source of the peritonitis and remove toxic peritoneal material. Key Words: Open abdomen, Vacuum-assisted closure, Severe peritonitis, Duodenal leak.