Examination of the usefulness of combined use of DPC and NPWT after emergency laparotomy for lower gastrointestinal perforation
【Purpose】 We investigate the usefulness of combined use of Delayed Primary Closure （DPC） and Negative Pressure Wound Therapy （NPWT） after emergency laparotomy for lower gastrointestinal perforation. 【Subjects and Methods】We retrospectively investigated 37 cases of lower gastrointestinal perforation...
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| Published in | Japanese Journal of Acute Care Surgery Vol. 12; no. 1; pp. 71 - 75 |
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| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
The Japanese Society for the Acute Care Surgery
2022
一般社団法人 日本Acute Care Surgery 学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 2436-102X |
| DOI | 10.50840/jjacs.12-20 |
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| Abstract | 【Purpose】 We investigate the usefulness of combined use of Delayed Primary Closure （DPC） and Negative Pressure Wound Therapy （NPWT） after emergency laparotomy for lower gastrointestinal perforation. 【Subjects and Methods】We retrospectively investigated 37 cases of lower gastrointestinal perforation corresponding to Hinchey classification Stage Ⅲ or Ⅳ who underwent emergency laparotomy. We divided 37 patients into a primary closure group and a group in which DPC and NPWT were used in combination. 【Results】 The incidence of Surgical Site Infection （SSI） between the two groups was 31.6％ vs 27.8％ （P＝0.80）, showing no statistically significant difference. However, the incidence of deep incisional SSI between two groups was 21.1％ vs 0.00％ （P＜0.05）, showing a statistically significant difference. 【Conclusion】 In patients who underwent emergency laparotomy for lower gastrointestinal perforation, the combined use of DPC and NPWT may reduce the incidence of deep incisional SSI. |
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| AbstractList | 【Purpose】 We investigate the usefulness of combined use of Delayed Primary Closure （DPC） and Negative Pressure Wound Therapy （NPWT） after emergency laparotomy for lower gastrointestinal perforation. 【Subjects and Methods】We retrospectively investigated 37 cases of lower gastrointestinal perforation corresponding to Hinchey classification Stage Ⅲ or Ⅳ who underwent emergency laparotomy. We divided 37 patients into a primary closure group and a group in which DPC and NPWT were used in combination. 【Results】 The incidence of Surgical Site Infection （SSI） between the two groups was 31.6％ vs 27.8％ （P＝0.80）, showing no statistically significant difference. However, the incidence of deep incisional SSI between two groups was 21.1％ vs 0.00％ （P＜0.05）, showing a statistically significant difference. 【Conclusion】 In patients who underwent emergency laparotomy for lower gastrointestinal perforation, the combined use of DPC and NPWT may reduce the incidence of deep incisional SSI.
〔要旨〕【目的】下部消化管穿孔の緊急開腹術後の開腹創に遷延一時縫合（delayed primary closure；DPC）と局所陰圧療法（negative pressure wound therapy；NPWT）を併用する治療法の有用性を検討する。【対象と方法】緊急開腹術を要した下部消化管穿孔のうち，Hinchey分類StageⅢまたはⅣに該当する37例を，一期的縫合群と，DPCとNPWTを併用する群に分け，後方視的に調査した。【結果】2群間の術後手術部位感染症（surgical site infection；SSI）発症率は31.6％ vs 27.8％（P＝0.80）と統計学的有意差を認めなかったが，深部SSI発症率にかぎると21.1％ vs 0.0％（P＜0.05）と統計学的有意差を認めた。【結論】下部消化管穿孔の緊急開腹手術後にDPCとNPWTを併用し，深部切開創SSI発生率を減少させる可能性が考えられた。 【Purpose】 We investigate the usefulness of combined use of Delayed Primary Closure （DPC） and Negative Pressure Wound Therapy （NPWT） after emergency laparotomy for lower gastrointestinal perforation. 【Subjects and Methods】We retrospectively investigated 37 cases of lower gastrointestinal perforation corresponding to Hinchey classification Stage Ⅲ or Ⅳ who underwent emergency laparotomy. We divided 37 patients into a primary closure group and a group in which DPC and NPWT were used in combination. 【Results】 The incidence of Surgical Site Infection （SSI） between the two groups was 31.6％ vs 27.8％ （P＝0.80）, showing no statistically significant difference. However, the incidence of deep incisional SSI between two groups was 21.1％ vs 0.00％ （P＜0.05）, showing a statistically significant difference. 【Conclusion】 In patients who underwent emergency laparotomy for lower gastrointestinal perforation, the combined use of DPC and NPWT may reduce the incidence of deep incisional SSI. |
| Author | Fukuzaki, Takayuki Kato, Junichiro Yamaguchi, Eiji Taniguchi, Yoshiki Sawano, Hirotaka Fukata, Tadafumi Ito, Yusuke Shingai, Tatsushi Hayashi, Yasuyuki Kittaka, Hirotada |
| Author_FL | 伊藤 裕介 Kittaka Hirotada 深田 唯史 真貝 竜史 山口 英治 澤野 宏隆 加藤 淳一郎 林 靖之 福﨑 孝幸 Taniguchi Yoshiki |
| Author_FL_xml | – sequence: 1 fullname: 加藤 淳一郎 – sequence: 2 fullname: Taniguchi Yoshiki – sequence: 3 fullname: 山口 英治 – sequence: 4 fullname: 深田 唯史 – sequence: 5 fullname: Kittaka Hirotada – sequence: 6 fullname: 伊藤 裕介 – sequence: 7 fullname: 林 靖之 – sequence: 8 fullname: 真貝 竜史 – sequence: 9 fullname: 澤野 宏隆 – sequence: 10 fullname: 福﨑 孝幸 |
| Author_xml | – sequence: 1 fullname: Taniguchi, Yoshiki organization: Depratment of Surgery, Saiseikai Senri Hospital – sequence: 1 fullname: Yamaguchi, Eiji organization: Senri Critical Care Medicine Center, Saiseikai Senri Hospital – sequence: 1 fullname: Kato, Junichiro organization: Depratment of Surgery, Saiseikai Senri Hospital – sequence: 1 fullname: Fukata, Tadafumi organization: Depratment of Surgery, Saiseikai Senri Hospital – sequence: 1 fullname: Ito, Yusuke organization: Senri Critical Care Medicine Center, Saiseikai Senri Hospital – sequence: 1 fullname: Kittaka, Hirotada organization: Senri Critical Care Medicine Center, Saiseikai Senri Hospital – sequence: 1 fullname: Hayashi, Yasuyuki organization: Senri Critical Care Medicine Center, Saiseikai Senri Hospital – sequence: 1 fullname: Fukuzaki, Takayuki organization: Depratment of Surgery, Saiseikai Senri Hospital – sequence: 1 fullname: Sawano, Hirotaka organization: Senri Critical Care Medicine Center, Saiseikai Senri Hospital – sequence: 1 fullname: Shingai, Tatsushi organization: Depratment of Surgery, Saiseikai Senri Hospital |
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| References | 7）Sasikumar MN, Mammen SC: Primary versus delayed wound closure technique in laparotomy wound of perforation peritonitis. Int Surg J. 2019; 6: 3708-3714. 13）上野修平，沢井博純，栗本昌明，他：大腸穿孔手術例の予後因子とスコアによる評価の検討．日腹部救急医会誌 2022；42（3）：349-354. 8）Siribumrungwong B, Chantrip A, Noorit P, et al.: Comparison of superficial surgical site infection between delayed primary versus primary wound closure in complicated appendicitis:a randomized controlled trial. Ann Surg 2018; 267: 631-637. 9）塩崎弘憲，嶋田元，須藤一起，他：下部消化管穿孔手術の創に対する遷延一時縫合の有用性について. 日腹部救急医会誌 2010；30：893-898. 6）伊藤裕介，稲葉基高，天野浩嗣，ほか：下部消化管穿孔症例におけるSSIの検討．日腹部救急医会誌 2012；32：1041-1044. 10）奥本真史，田原由季，真海厚美，他：局所陰圧閉鎖療法 （Negative Pressure Wound Therapy）に繊維芽細胞増殖因子を併用した症例．日農医誌 2012；61：643-648. 4）樋口亮太，安田秀喜，幸田圭史，他：汎発性腹膜炎手術例における腹壁瘢痕ヘルニア発生とその予防．日腹部救急医会誌 2010；30：899-904. 12）Vincent JL, Moreno R, Takala J, et al.: The SOFA （Sepsis-related Organ Failure Assessment） score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996; 22: 707-710. 3）Mangram AJ, Horan TC, Pearson ML: Guideline for the prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999; 20: 250-278. 2）Hinchey EJ, Schaal PG, Richards GK: Treatment of perforated diverticular disease of the colon. Adv Surg 1978; 12: 85-109. 5）清水昇一，塩谷猛：下部消化管手術SSI発症率の減少を目的としたSSI対策バンドルの有効性に関する検討．日外感染症会誌 2018；15：122-129. 11）Knaus WA, Draper EA, Wagner DP, et al.: APACHEⅡ; a severity of disease classification system. Clit Care Med 1985; 13: 818-829. 1）Ota H, Danno K, Ohta K, et al: Efficacy of negative pressure wound therapy followed by delayed primary closure for abdominal wounds in patients with lower gastrointestinal perforations: multicenter prospective study. J Anus Rectum Colon 2020; 4: 114-121. |
| References_xml | – reference: 6）伊藤裕介，稲葉基高，天野浩嗣，ほか：下部消化管穿孔症例におけるSSIの検討．日腹部救急医会誌 2012；32：1041-1044. – reference: 9）塩崎弘憲，嶋田元，須藤一起，他：下部消化管穿孔手術の創に対する遷延一時縫合の有用性について. 日腹部救急医会誌 2010；30：893-898. – reference: 12）Vincent JL, Moreno R, Takala J, et al.: The SOFA （Sepsis-related Organ Failure Assessment） score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996; 22: 707-710. – reference: 8）Siribumrungwong B, Chantrip A, Noorit P, et al.: Comparison of superficial surgical site infection between delayed primary versus primary wound closure in complicated appendicitis:a randomized controlled trial. Ann Surg 2018; 267: 631-637. – reference: 3）Mangram AJ, Horan TC, Pearson ML: Guideline for the prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999; 20: 250-278. – reference: 1）Ota H, Danno K, Ohta K, et al: Efficacy of negative pressure wound therapy followed by delayed primary closure for abdominal wounds in patients with lower gastrointestinal perforations: multicenter prospective study. J Anus Rectum Colon 2020; 4: 114-121. – reference: 4）樋口亮太，安田秀喜，幸田圭史，他：汎発性腹膜炎手術例における腹壁瘢痕ヘルニア発生とその予防．日腹部救急医会誌 2010；30：899-904. – reference: 5）清水昇一，塩谷猛：下部消化管手術SSI発症率の減少を目的としたSSI対策バンドルの有効性に関する検討．日外感染症会誌 2018；15：122-129. – reference: 11）Knaus WA, Draper EA, Wagner DP, et al.: APACHEⅡ; a severity of disease classification system. Clit Care Med 1985; 13: 818-829. – reference: 13）上野修平，沢井博純，栗本昌明，他：大腸穿孔手術例の予後因子とスコアによる評価の検討．日腹部救急医会誌 2022；42（3）：349-354. – reference: 10）奥本真史，田原由季，真海厚美，他：局所陰圧閉鎖療法 （Negative Pressure Wound Therapy）に繊維芽細胞増殖因子を併用した症例．日農医誌 2012；61：643-648. – reference: 2）Hinchey EJ, Schaal PG, Richards GK: Treatment of perforated diverticular disease of the colon. Adv Surg 1978; 12: 85-109. – reference: 7）Sasikumar MN, Mammen SC: Primary versus delayed wound closure technique in laparotomy wound of perforation peritonitis. Int Surg J. 2019; 6: 3708-3714. |
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| SubjectTerms | delayed primary closure Hinchey classification Hinchey分類 lower gastrointestinal perforation negative pressure wound therapy surgical site infection 下部消化管穿孔 局所陰圧療法 術後創部感染 遷延一時縫合 |
| Title | Examination of the usefulness of combined use of DPC and NPWT after emergency laparotomy for lower gastrointestinal perforation |
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