RESUMO
BACKGROUND: Survival in critically ill non-trauma patients may be improved by performing temporary abdominal closure using different surgical techniques. We describe the use of expanded polytetrafluoroethylene (ePTFE) mesh for temporary abdominal closure in a group of critical patients. We also evaluate definitive abdominal wall closure in these patients once they are in a stable condition. METHOD: We conducted a study of 29 critically ill non-trauma patients who underwent temporary abdominal closure due to sepsis or abdominal compartment syndrome over 7 years at two university hospitals. We analysed factors related to surgical wound type and definitive abdominal wall closure. We evaluated the SAPS 3 severity score and used it to obtain expected mortality. We used the Clavien-Dindo System for Surgical Complications and the Ventral Hernia Working Group Classification during follow-up. RESULTS: Performing temporary abdominal closure with expanded polytetrafluoroethylene mesh was associated with a mortality rate of 20.68%, which was lower than the expected mortality calculated from the SAPS 3 severity score (38.87 ± 21.60). There was no fistula formation related with this type of prosthetic material. In our study group, definitive abdominal wall closure was performed in the 16 patients who survived (69.5%), and six of them underwent this procedure during the original hospital stay. CONCLUSION: Temporary abdominal closure with ePTFE mesh is an effective alternative in some circumstances. We observed a higher survival rate than the predicted figure and there were no cases of enteroatmospheric fistulae using this particular surgical technique. ePTFE facilitates definitive abdominal wall closure, once the patient is in a stable condition.
Assuntos
Parede Abdominal/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais , Estado Terminal/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa , Politetrafluoretileno , Estudos Retrospectivos , Telas CirúrgicasAssuntos
Técnicas de Fechamento de Ferimentos Abdominais , Descompressão Cirúrgica/métodos , Hipertensão Intra-Abdominal/cirurgia , Laparotomia , Pancreatite/cirurgia , Politetrafluoretileno , Telas Cirúrgicas , Doença Aguda , Desenho de Equipamento , Feminino , Humanos , Hipertensão Intra-Abdominal/etiologia , Masculino , Pessoa de Meia-Idade , Pancreatite/complicações , Índice de Gravidade de Doença , Fatores de TempoRESUMO
Gunshot wounds, and in particular chest gunshot wounds, are becoming a growing problem in daily practice at many hospitals. Many authors propose a conservative attitude in certain cases. We present a patient with a chest gunshot wound successfully solved under conservative means and videothoracoscopic removal of the bullet.