Untersuchung des intraabdominellen Druckes im Verlauf der Laparostomatherapie
Background: In the surgical therapy of mechanical obstruction, peritonitis or trauma, the primary closure of the abdominal wall is frequently impossible. Objective parameters for determination of the abdominal wall closure after laparostomy are not known yet. So far, the intra-abdominal pressure (IAD) has not been evaluated as a criterion regarding the feasibility of fascial closure.Patients and Methods: The intravesical pressure (IVD) was used to assess IAD. The resulting IVD was compared with the IAD of two control groups. 15 patients were examined during laparoscopic surgery. IVD was measured during pneumoperitoneum and was compared to the IAD of the Laparoflator. The second control group consisted of 100 patients undergoing elective abdominal surgery (resection of the small bowel (12%), colo-rectal resection (28%), multivisceral resection (27%)). IVD was measured immediate after surgery. The studygroup consisted of 42 patients a laparostomy was applied to (24 female/18 male). The average age was 58,1 ± 17,2 years. Indication for applying a laparostomy were peritonitis (43%, average MPI 31), intestinal ischemia (27%), mechanical obstruction (21%), intraabdominal bleeding (7%) and trauma (2%). There was a standard procedure to apply the Laparostoma: After median laparotomy a net of polyglactin (Vicryl®, Ethicon, Hamburg) with the size 28 x 18 cm was sutured (1er Vicryl, Ethicon) to the abdominal wall. In 23 of 42 patients (55%), the definite closure of the abdomen was performed. In this group IVD was evaluated for seen days: three days before and three days after closure of the abdomen and at the day of surgery. Furthermore, parameters of ardio-circulatory, renal, pulmonary and liver function were recorded. The APACHE II Score was recorded. For statistical analysis, t-test and analysis of variance (ANOVA) were used. Significant was p < 0,05. To compare the agreement of IVD and pressure of the Laparoflator, the approach of Bland and Altman was used.
info:eu-repo/classification/ddc/610, Bauch, Kompartmentsyndrom, Hydrostatischer Druck, Laparotomie, Medizin, Abdomen, Compartment Syndromes, Hydrostatic Pressure, Monitoring, Laparotomy
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