Laparostoma: a useful surgical tool
Keywords:
Laparostoma, Abdominal compartment syndrome, Bogota bagAbstract
Background:Closure of the abdomen has always been a challenging task especially in the emergency setting with presence of bowel edema, haemoperitoneum, peritonitis. The aim of this study is to assess the role of laparostoma in such cases where closure of abdomen is difficult or under tension.
Methods:Retrospective analysis of 15 cases of laparostoma done either at primary surgery or re-exploration when abdominal closure was under tension. Laparostoma was done using nonadhesive plastic like sterile urine collecting bag to cover the exposed bowel. Mortality, whether closure of abdomen could be achieved at a later date, bowel complications due to laparostoma, need for mesh/skin grafting were noted.
Results:Of 15 patients with laparostoma, 9 were cases of perforative peritonitis and 4 were blunt abdominal trauma. Age ranged from 19 to 65 year. Abdominal wall closure could be achieved in a median of 15 days. Closure of rectus sheath could be achieved in 4 patients while in 8 patients only skin closure was done with the intention of closing incisional hernia after full recovery.
Conclusions:When closure of the abdomen is likely to be under tension creation of a laparostoma would help to prevent abdominal compartment syndrome with its systemic complications. It is also likely to cause less damage to the skin and rectus than methods like tension band wiring. The abdomen can be closed at a later date once the edema settles without undue tension on the abdominal wall.
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References
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