Vacuum-assisted laparotomy in patients with penetrating gunshot wounds to the abdomen

BACKGROUND: In modern armed conflicts, peritonitis incidence in penetrating abdominal injuries involving hollow organ damage reaches 31%.

AIM: This study aimed to evaluate the effectiveness of vacuum-assisted laparotomy as a temporary abdominal closure technique in the open abdomen approach for patients with penetrating abdominal gunshot wounds complicated by peritonitis.

METHODS: The outcomes of vacuum-assisted laparostomy were analyzed in 100 patients with penetrating abdominal gunshot wounds complicated by peritonitis between March 1, 2022, and March 1, 2024. The patients were divided into three groups based on hospital department and clinical outcome: group 1, 9 patients from the surgical department; group 2, 59 wounded patients from the anesthesiology and intensive care unit who underwent definitive abdominal closure; and group 3, 32 patients with documented in-hospital mortality. The patients in groups 1 and 2 were further subdivided according to definitive abdominal closure technique: layered closure of the abdominal wall (primary fascial closure) or skin-only closure of the laparotomy wound (planned ventral hernia) performed during the final relaparotomy. Each relaparotomy was performed with vacuum-assisted laparotomy according to a standardized protocol. Predictive models to achieve primary fascial closure and for in-hospital mortality were developed.

RESULTS: Primary fascial closure was achieved in 78% of group 1 cases and in 29% of group 2 cases (p < 0.007). In group 2, the planned ventral hernia subgroup had significantly more relaparotomies (p < 0.001), longer open abdomen duration (p < 0.001), and longer intensive care unit stays (p = 0.008) than the primary fascial closure subgroup. An increase in the duration of open abdomen management (group 2) by 1 day decreased the possibility of primary fascial closure by 18% (odds ratio [OR] = 0.817; 95% confidence interval [CI]: 0.706–0.945; p = 0.007). In group 2, a decrease in the interval between surgical interventions was a predictor of in-hospital mortality (OR = 0.934; 95% CI: 0.876–0.997; p = 0.040). An increase in patient age by 1 year increased the possibility of death by 15% (OR = 1.153; 95% CI: 1.035–1.284; p = 0.010), whereas a 1 point increase in organ failure severity score at the initiation of open abdomen approach increased it by 82% (OR = 1.817; 95% CI: 1.255–2.632; p = 0.002).

CONCLUSION: Achieving primary fascial closure is associated with a smaller number of preceding surgical interventions and duration of intensive care unit treatment. The shorter the open abdomen duration, the higher the possibility of primary fascial closure. Patient age and the initial organ failure severity score are potential predictors of in-hospital mortality in patients with penetrating abdominal gunshot wounds complicated by peritonitis.