Systemic Review of Open Abdomen versus Primary Closure after Emergency Laparotomy for Peritonitis: Experience in Qazi Hussain Ahmed Medical Complex, Nowshera, Pakistan.
DOI:
https://doi.org/10.47672/ajhmn.1012Keywords:
Systematic review, Open abdomen, primary closure, emergency laparotomy, PeritonitisAbstract
Objective: In secondary peritonitis patients, optimal management after index laparotomy is poorly defined. Although an open abdomen or temporary abdominal closure with planned relaparotomy is used to reassess bowel viability or contamination severity, recent studies show that primary abdominal closure has comparable morbidity and mortality. The differences between Open Abdomen (OP) and Primary Closure (PC) after emergent laparotomy are examined in this study.
Material and Methods: A systemic review on open abdomen versus primary closure after emergency laparotomy for peritonitis from January 2017 to December 2021 were analyzed. This systemic review was conducted in the department of surgical Qazi Hussain Ahmad Medical complex, Nowshera, Pakistan with approval from the hospital ethical and research committee. The study enrolled 200 patients who met the eligibility requirements. A lottery method was used to divide the patients into two groups at random. Patients with secondary peritonitis requiring emergent laparotomy were identified (N = 200) using the Premier database at a quaternary level. Mannheim Peritonitis Index, lactate, and vasopressor requirement were used to perform propensity matching for PC (n = 100; 65%) or OA (n = 100; 35%). A total of 200 closely matched pairs (PC: OA) were examined.
Results: About 65 percent of the 200 women patients enrolled in the study had an emergency laparotomy (mean age of 52.2 years). Only one relaparotomy was performed on 100 (65.0%) of the (O.A) patients, while 35 (35.0%) had multiple reoperations. Overnight (4 pm-4 am) laparotomies had more temporary closures with O.A (35.0 percent OA vs. 65.0 percent PC, p = 0.05) than daytime laparotomies. Surgical subspecialties performed PC in 82.1 percent of laparotomies, compared to 35.0 percent (p 0.0002) of acute care surgeons. Postoperative complications and n-100 (65.0 percent vs. 35.0 percent, p = 0.0002), mortality (18.0 percent vs. 09.2 percent, p = 0.005), and a longer median length of stay (12 vs. 12 days p = 0.0001) were all higher in OA patients.
Conclusion: The study's systemic review revealed that compared to PC, the complications, mortality rates, and costs associated with OA were significantly higher. Given these findings, more research is needed to determine appropriate OA indications.
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Copyright (c) 2022 Muddasar shahzad, Kamran Ahmad, Fazal Ghani, Kamran Hakeem Khan
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