Guagni Tommaso, Prosperi P, Marzano M, Falcone A, Bussotti Matteo, Bergamini C, Mastronardi M, Giordano A
Unit of Emergency Surgery, Careggi University Hospital, Florence, Italy.
Surgical Clinic Unit, Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Trieste, Italy.
Langenbecks Arch Surg. 2025 Apr 26;410(1):147. doi: 10.1007/s00423-025-03693-w.
WSES guidelines allow open abdomen (OA) for critically ill patients due to secondary peritonitis in the case of inadequate source control, but this option results quite vague and with a low grade of evidence (Grade 2 C). Moreover, the emerging increasing in literature of complications, makes the use of OA in secondary peritonitis more debated. The aim of our study is to analyze the postoperative outcomes of patients undergoing OA versus primary closure (PC) in secondary peritonitis.
We collected data from Tertiary Trauma Center from 2019 to 2024. The study included patients who underwent urgent laparotomy for severe secondary peritonitis, divided into two groups based on the strategy chosen in the index laparotomy: PC or OA. We retrospectively analyzed the data, considering as primary outcome post-operative mortality, while as secondary outcomes short terms complications and LOS.
283 patients fit the research for the diagnosis of peritonitis but only 176 were included as with a WSES-SSS > = 7. 128 patients (72,7%) were in the PC group, while 48 (27,3%) were managed with an OA strategy. There were no statistical differences in terms of mortality (p = 0.371), between the two groups. Complications were higher in the OA group (p = 0.001). From the logistic regression only MPI resulted an independent factor of mortality (p = 0.016; OR 1.080).
The study shows that OA in severe secondary peritonitis does not improve mortality and is associated with higher short-term complications and incisional hernias. However, RCT are necessary to better investigate the role of OA in the management of abdominal sepsis.
世界急诊外科学会（WSES）指南允许在重症患者因继发性腹膜炎而源控制不充分时采用开放腹腔（OA），但这种选择相当模糊且证据等级较低（2C级）。此外，文献中并发症的出现日益增多，使得在继发性腹膜炎中使用OA更具争议性。我们研究的目的是分析继发性腹膜炎患者接受OA与一期缝合（PC）后的术后结局。
我们收集了2019年至2024年三级创伤中心的数据。该研究纳入了因严重继发性腹膜炎接受急诊剖腹手术的患者，根据首次剖腹手术中选择的策略分为两组：PC组或OA组。我们回顾性分析数据，将术后死亡率作为主要结局，短期并发症和住院时间作为次要结局。
283例患者符合腹膜炎诊断研究，但只有176例因WSES-SSS≥7而被纳入。128例患者（72.7%）在PC组，而48例（27.3%）采用OA策略治疗。两组之间在死亡率方面无统计学差异（p = 0.371）。OA组并发症更高（p = 0.001）。从逻辑回归分析来看，只有改良POSSUM死亡率指数（MPI）是死亡率的独立因素（p = 0.016；OR 1.080）。
该研究表明，严重继发性腹膜炎中OA并不能提高生存率，且与更高的短期并发症和切口疝相关。然而，需要进行随机对照试验以更好地研究OA在腹部脓毒症管理中的作用。
