Belsariya Vivek, Kundan Meghraj, Nyekha Vekhotso, Chandra J Nemi
General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND.
Cureus. 2024 May 21;16(5):e60738. doi: 10.7759/cureus.60738. eCollection 2024 May.
Background Intestinal perforation is a life-threatening condition requiring immediate surgical intervention. Surgical-site infections (SSIs) and wound dehiscence are common complications associated with emergency laparotomy for intestinal perforation. Finding optimal wound management and postoperative strategies can significantly impact patient outcomes and reduce the risk of complications. Negative-pressure wound therapy (NPWT) is a relatively recent tool employed in the care of wounds to control SSIs and foster healing. Methodology A prospective, observational, cohort study was conducted among 150 patients who underwent emergency exploratory laparotomy due to intestinal perforation at the general surgery department of a tertiary care hospital in New Delhi between July 2022 and December 2023. Preoperatively, all patients underwent initial resuscitation. Intraoperatively, the extent of peritonitis was determined and was categorized according to the Centers for Disease Control and Prevention (CDC) classification. Postoperatively, NPWT dressing was applied to the patient's midline laparotomy wound on postoperative day (POD) two. Negative pressure was set at 75-125 mmHg with suction. The number of NPWT dressing changes required was documented. The wound was closed with vertical mattress sutures under local anesthesia, delayed primary closure (DPC). The incidence of SSIs, the duration for DPC, the incidence of fascial dehiscence, the number of NPWT dressing changes, and the length of hospital stay were documented according to CDC groups. Results The mean age in CDC categories 2, 3, and 4 were 31.789, 28.733, and 42.676 years, respectively. The most common cause of perforation was enteric fever (n = 42, 28%), followed by tuberculosis (n = 36, 24%). Most patients had no known comorbidities (n = 80, 53.3%). Overall, 16% of patients (n = 24) were both alcoholics and smokers. The most frequent bacteria in all CDC categories was . Fourteen patients developed burst abdomen in the postoperative period and were excluded from the study. The mean duration of DPC increased with higher CDC categories, with CDC category 4 displaying the most extended mean duration at 10.70 days. The number of NPWT dressing changes increases with higher CDC categories, with CDC category 4 exhibiting the highest mean at 2.00 changes. The mean hospital stay increased with higher CDC categories, with CDC category 4 showing the most extended mean stay at 17.324 days. Statistical analysis revealed no significant association between SSI occurrence and CDC categories. Conclusions NPWT followed by DPC is a promising approach to managing gastrointestinal perforations, reducing SSIs, and potentially improving patient outcomes. However, further research is needed to explore the specific benefits of NPWT in conjunction with DPC and its efficacy in various clinical scenarios.
肠穿孔是一种危及生命的疾病，需要立即进行手术干预。手术部位感染（SSIs）和伤口裂开是与肠穿孔急诊剖腹手术相关的常见并发症。找到最佳的伤口处理和术后策略可显著影响患者预后并降低并发症风险。负压伤口治疗（NPWT）是一种相对较新的用于伤口护理以控制SSIs和促进愈合的工具。
2022年7月至2023年12月期间，在新德里一家三级护理医院的普通外科，对150例因肠穿孔接受急诊探查性剖腹手术的患者进行了一项前瞻性、观察性队列研究。术前，所有患者均接受初始复苏。术中，确定腹膜炎的程度，并根据疾病控制与预防中心（CDC）分类进行分类。术后，在术后第二天（POD）对患者的中线剖腹手术伤口应用NPWT敷料。负压设置为75 - 125 mmHg进行吸引。记录所需的NPWT敷料更换次数。伤口在局部麻醉下用垂直褥式缝线闭合，延迟一期缝合（DPC）。根据CDC分组记录SSIs的发生率、DPC的持续时间、筋膜裂开的发生率、NPWT敷料更换次数和住院时间。
CDC分类2、3和4组的平均年龄分别为31.789岁、28.733岁和42.676岁。最常见的穿孔原因是肠热症（n = 42，28%），其次是结核病（n = 36，24%）。大多数患者无已知合并症（n = 80，53.3%）。总体而言，16%的患者（n = 24）既是酗酒者又是吸烟者。所有CDC分类中最常见的细菌是 。14例患者术后发生腹部裂开，被排除在研究之外。DPC的平均持续时间随CDC分类升高而增加，CDC分类4组的平均持续时间最长，为10.70天。NPWT敷料更换次数随CDC分类升高而增加，CDC分类4组的平均次数最高，为2.00次。平均住院时间随CDC分类升高而增加，CDC分类4组的平均住院时间最长，为17.324天。统计分析显示SSI发生与CDC分类之间无显著关联。
NPWT后行DPC是一种有前景的管理胃肠道穿孔、减少SSIs并可能改善患者预后的方法。然而，需要进一步研究以探索NPWT与DPC联合使用的具体益处及其在各种临床场景中的疗效。
