Zavizion Y. The choice of finishing method in relaparаtomy

The work describes evaluation of treatment results of 156 patients aged 18 to 75 years with acute abdominal distress requiring relaparotomy. Group I includes 69 patients, whose results of operations were evaluated retrospectively. To determine the features of complications, depending on the method of surgery completing, patients of I group were divided into subgroups I-a - surgical wound was sealed layer by layer, and I-b - only skin was sealed. Group II consists of 87 patients who had secondary surgeries with the use of a differential approach to the completion of relaparotomy, depending on level of intra-abdominal pressure and the degree of wound contamination, including layer by layer sealing, sealing only the skin and alloplasty of the front abdominal wall with the formation of a stable diastase of musculi recti abdomimis. On the basis of the obtained results, a differentiated approach to the completion oflast relaparotomy was developed depending on the intra-abdominal pressure at surgery completion and level of median woundmicrobe contamination. Thus, patients with an uncontaminated abdominal cavity with intra-abdominal pressure atrelaparotomy completion less than 14 mm Hg. had layer inlayer of surgical wound sealing; intra-abdominal pressure 14 - 19 mm Hg. - front abdominal wall aloplasty with the formation of stable diastase of the musculi recti abdomimis was used; abdominal pressure over 19 mm Hg. - only skin was sealed. Patients with contaminated abdominal cavity with intra-abdominal pressure at the relaparotomy completion less than 14 mm Hg.had layer bylayer of surgical wound sealing; intra-abdominal pressure 14 - 19 mm Hg. and the amount of CFU/ml ?103-front abdominal wall aloplasty with formation of stable diastase of the musculi recti abdomimis was used; abdominal pressure over 19 mm Hg., or more than 14 mm Hg. and the amount of CFU / ml ?104- only skin was sealed. Due to use ofdifferentiated approach to relaparotomy completion, it was possible to prevent development of abdominal compartment syndrome in early aftersurgery period and reduce the rate of hernias formation in non-contaminated abdominal cavity by 47,6 %, in contaminated - by 35,1 %.