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Continuous peritoneal lavage with vacuum peritoneostomy: an experimental study
Rodrigues, Adilson Costa; Saad, Karen Ruggeri; Saad, Paulo Fernandes; Otsuki, Denise Aya; Santos, Luana Carla dos; Rasslan, Samir; Montero, Edna Frasson de Souza; Utiyama, Edivaldo M.
  • Rodrigues, Adilson Costa; Universidade de Sao Paulo. Faculdade de Medicina. Cirurgia, Hospital das Clinicas HCFMUSP. Sao Paulo. BR
  • Saad, Karen Ruggeri; Universidade Federal do Vale do São Francisco. Faculdade de Medicina. Petrolina. BR
  • Saad, Paulo Fernandes; Universidade Federal do Vale do São Francisco. Faculdade de Medicina. Petrolina. BR
  • Otsuki, Denise Aya; Universidade de Sao Paulo. Faculdade de Medicina FMUSP. Laboratorio de Anestesiologia (LIM-08). Sao Paulo. BR
  • Santos, Luana Carla dos; Universidade de Sao Paulo. Faculdade de Medicina FMUSP. Laboratorio de Fisiopatologia Cirurgica (LIM-62). Sao Paulo. BR
  • Rasslan, Samir; Universidade de Sao Paulo. Faculdade de Medicina FMUSP. Laboratorio de Fisiopatologia Cirurgica (LIM-62). Sao Paulo. BR
  • Montero, Edna Frasson de Souza; Universidade de Sao Paulo. Faculdade de Medicina FMUSP. Laboratorio de Fisiopatologia Cirurgica (LIM-62). Sao Paulo. BR
  • Utiyama, Edivaldo M; Universidade de Sao Paulo. Hospital das Clinicas HCFMUSP. Clinica Cirurgica III. Sao Paulo. BR
Clinics ; 74: e937, 2019. tab, graf
Article in English | LILACS | ID: biblio-1011913
ABSTRACT

OBJECTIVE:

Despite advances in diffuse peritonitis treatment protocols, some cases develop unfavorably. With the advent of vacuum therapy, the use of laparostomy to treat peritonitis has gained traction. Another treatment modality is continuous peritoneal lavage. However, maintaining this technique is difficult and has been associated with controversial results. We propose a new model of continuous peritoneal lavage that takes advantage of the features and benefits of vacuum laparostomy.

METHOD:

Pigs (Landrace and Large White) under general anesthesia were submitted to laparostomy through which a multiperforated tube was placed along each flank and exteriorized in the left and lower right quadrants. A vacuum dressing was applied, and intermittent negative pressure was maintained. Peritoneal dialysis solution (PDS) was then infused through the tubes for 36 hours. The stability of peritoneostomy with intermittent infusion of fluids, the system resistance to obstruction and leakage, water balance, hemodynamic and biochemical parameters were evaluated. Fluid disposition in the abdominal cavity was analyzed through CT.

RESULTS:

Even when negative pressure was not applied, the dressing maintained the integrity of the system, and there were no leaks or blockage of the catheters during the procedure. The aspirated volume by vacuum laparostomy was similar to the infused volume (9073.5±1496.35 mL versus 10165±235.73 mL, p=0.25), and there were no major changes in hemodynamic or biochemical analysis. According to CT images, 60 ml/kg PDS was sufficient to occupy all intra-abdominal spaces.

CONCLUSION:

Continuous peritoneal lavage with negative pressure proved to be technically possible and may be an option in the treatment of diffuse peritonitis.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Peritoneum / Peritoneal Lavage / Negative-Pressure Wound Therapy / Laparotomy Type of study: Practice guideline Limits: Animals Language: English Journal: Clinics Journal subject: Medicine Year: 2019 Type: Article Affiliation country: Brazil Institution/Affiliation country: Universidade Federal do Vale do São Francisco/BR / Universidade de Sao Paulo/BR

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Full text: Available Index: LILACS (Americas) Main subject: Peritoneum / Peritoneal Lavage / Negative-Pressure Wound Therapy / Laparotomy Type of study: Practice guideline Limits: Animals Language: English Journal: Clinics Journal subject: Medicine Year: 2019 Type: Article Affiliation country: Brazil Institution/Affiliation country: Universidade Federal do Vale do São Francisco/BR / Universidade de Sao Paulo/BR