NPWT vs Primary Closure in SSI Prevention for Emergency Laparotomies for Peritonitis (PRISTINE)
Peritonitis, Surgical Site Infection, Infections
About this trial
This is an interventional health services research trial for Peritonitis focused on measuring laparotomy, NPWT, primary closure, vacuum-assisted closure, VAC
Eligibility Criteria
Inclusion Criteria: qualified for an emergency laparotomy for peritonitis gave written informed consent Exclusion Criteria: qualified for open abdomen treatment
Sites / Locations
- UCC Division of Oncological, Transplant and General SurgeryRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
No Intervention
subcutaneous NPWT
primary closure
The peritoneum and fascia will be closed as in the PC arm. Subsequently, patients will be treated with commercially available vacuum-assisted closure systems (provided by Smith&Nephew or Hartmann) according to the manufacturer's instructions. Following fascia closure, the NPWT foam will be adjusted to the wound size to fill the wound cavity without causing excessive wound dehiscence. Subsequently, the foam will be placed in the subcutaneous tissue. The foam will not be fixated on the skin with sutures. The wound will be sealed with adhesive film. In case of air leak in problematic areas such as the navel or ostomy, ostomy paste will be used to create a tighter seal. Continuous pressure of 120 mmHg will be applied. On the 3rd day postop, the dressing will be removed and closure by secondary intention will be performed.
The peritoneum will be closed as a separate layer with a 2-0 multifilament absorbable suture. Subsequently, the fascia will be closed with a continuous suture using absorbable monofilament 0 sutures. Subcutaneous tissue will be rinsed twice with hypochlorite solution following peritoneal closure and fascial closure. Interrupted subcutaneous closure will be performed with absorbable multifilament 2-0 sutures. Following skin disinfection with an alcohol solution, the skin will be closed with non-absorbable monofilament 2-0 or 3-0 sutures using the interrupted mattress technique. Conventional Cosmopor® sterile gauze dressings will be applied. Unless the dressing material will be saturated, the dressing will remain unchanged until 3rd day post-op.