Neue Anwendung der V.A.C.®-Therapie in der Bauchhöhle bei offenem Abdomen

Zusammenfassung

Ziel der Untersuchung: Das Problem der Vakuumversiegelung (Vacuum Assisted Closure, V.A.C.® ) beim offenen Abdomen liegt darin, dass die zu drainierenden Flüssigkeiten aufgrund des Unterdruckes der V.A.C.®-Therapie zentripetal durch die Peritonealhöhle fließen und im Fall einer lokalen intraabdominalen Infektion, diese sich entlang des Druckgradienten in der ganzen Bauchhöhle ausbreitet.
Methodik: Die bisher angewandte Technik der V.A.C.®-Therapie bei offenem Abdomen wurde durch die Einlage eines zusätzlichen intraabdominalen V.A.C.®-Systems modifiziert, das mittels eines separaten Schlauches durch die Bauchwand drainiert wurde. Diese Anordnung mit unterschiedlichen Unterdruckgradienten verhinderte die Ausbreitung einer intraabdominalen Infektion bei nekrotisierender Pankreatitis nach Pankreasruptur.
Resultate: Die Drainagevolumina des intraabdominalen V.A.C.®- Systems und der Vakuumversiegelung für das offene Abdomen waren gleich. Vor dem Faszienverschluss nach 72 Tagen der Behandlung mittels offenem Abdomen waren 30 Reoperationen nötig. Es wurden weder Darmfisteln noch intraabdominale Abszesse beobachtet. In der Nachbeobachtungszeit traten bisher keine Narbenhernien der Bauchwand auf.
Schlussfolgerungen: Ein zusätzliches intraabdominales V.A.C.®- System mit separater Drainage kombiniert mit der üblichen Vakuumversiegelung bei der Behandlung des offenen Abdomens mit unterschiedlichen Unterdruckgradienten führt zu einer Kompartimentierung einer intraabdominalen Infektsituation und verhindert die Ausbreitung in der Abdominalhöhle.

Abstract

Objective: The problem of the temporary vacuum assisted closure (V.A.C.®) of open abdomen situation is that the fluids, following the negative pressure, pass the abdominal cavity and in case of a local infection disseminate over the whole abdominal cavity.
Methods: The usual open abdominal wound V.A.C.® technique was modified by using an auxiliary, independently operating V.A.C.® system positioned intra-abdominally and connected with a separate drainage tube introduced into the lateral abdominal wall. This arrangement prevents further spreading of a local intra-abdominal infection in case of a necrotising pancreatitis after traumatic pancreas rupture.
Results: The drainage volumes were comparable from superficial and intra-abdominal V.A.C.® system. A total of 30 reoperations were necessary due to a leasion of the pancreas before a primary closure of the open abdominal wound could be applied after 72 days. No bowel fistulas or intra-abdominal abscess formations were observed. The follow-up have not shown any hernia of the abdominal wall up to the present.
Conclusion: Additional intra-abdominally positioned V.A.C.® system with an own drainage system supports open abdomen therapy with the standard abdominal V.A.C.® system and prevents dissemination of intra-abdominal infection.

Schlüsselwörter

Offenes Abdomen - Infektion - Vakuumversiegelung - V.A.C.®

Key words

Open abdomen - infection - Vacuum assisted closure - V.A.C.®

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