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Vacuum Assisted Closure Versus On-demand Relaparotomy in Patients With Fecal or Diffuse Peritonitis (VACOR)

Primary Purpose

Fecal Peritonitis, Secondary Peritonitis, Diffuse; Peritonitis

Status
Recruiting
Phase
Not Applicable
Locations
Denmark
Study Type
Interventional
Intervention
Vacuum assisted closure
Relaparotomy "on demand"
Sponsored by
Odense University Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Fecal Peritonitis

Eligibility Criteria

19 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

Patients eligible for enrolment are 18+ years of age and are scheduled for acute laparotomy due to suspected peritonitis originating from perforation of the small bowel, colon, or rectum. To be included, purulent, enteric, or fecal contamination in a minimum of 2 out of 4 quadrants must be confirmed.

Exclusion Criteria:

  • Diffuse peritonitis originating from a different focus than the small intestine, colon or rectum
  • Diffuse peritonitis originating from a perforation on the stomach, duodenum, gallbladder, appendix, necrotizing pancreatitis, salpingitis, or peritoneal dialysis
  • Primary peritonitis
  • Immunocompromised (ongoing chemotherapy or prednisolone >20 mg/day)
  • Chronic parenchymal liver disease
  • Pregnancy
  • Patients with end-stage disease
  • Laparoscopic surgery (not converted to laparotomy)
  • Acute occlusion of superior mesenteric artery
  • Peritoneal carcinomatosis
  • Abdominal trauma
  • Lack of consent from the surgical equipoise
  • Local peritonitis confined to 1 quadrant only

Sites / Locations

  • Odense University HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Vacuum assisted closure

Relaparotomy "on-demand"

Arm Description

The VAC® Abdominal Dressing System (KCI Vacuum Assisted Closure, San Antonio, TX, USA) will be used. Intestines, including lateral aspects, are covered by the visceral protective layer. The first layer of foam is placed in the laparostoma on the visceral protective layer and must extend below the fascia at a distance of 5 cm from the facial opening. Above this, a minimum of one piece of foam is folded and placed in the laparostoma. Finally, the laparostoma will be covered by the occlusive drape. A circular opening of approximately 5 cm in diameter will be created in the drape where the connection tubes to the vacuum pump will be placed. Simultaneously while applying the negative pressure of 125 mmHg, the wound edges are approximated manually towards the midline. Each dressing change must be performed in the operation theatre with the patient in general anesthesia and muscle relaxation.

The Isreaelsson principle includes a running suture of the fascia with a distance of 5 mm between the stitches of 5 mm and the distance to the facial edge of 5-10 mm. Monofilament PDS 2-0 or equivalent is used. The suturing is started cranially and caudally, and the sutures are tied with self-locking knots. Four times as much suture material as the length of the wound must be used. The peritoneal fluid must be cultured at closure. The treating surgeon decides to perform a ROD and should be guided by the patient's general condition, gastrointestinal function, renal function, and inflammatory parameters at daily rounds.

Outcomes

Primary Outcome Measures

Primary endpoint is to compare peritonitis related complications and Comprehensive Complication Index (CCI) between NPWT treatment (VAC) and conventional treatment (ROD) at 30, 90 days and 1 year.
Disease-Related Major Morbidity Needing Readmission and Conservative Treatment but Not Surgery Fistula Wound dehiscence/incisional hernia with obstruction Abscess needing percutaneous drainage Renal failure Myocardial infarction Gastric or duodenal bleeding Respiratory failure Urosepsis Disease-Related Major Morbidity Needing Surgical Intervention During First Admission or Readmission Incisional hernia Bowel obstruction or herniation due to intra-abdominal adhesions Burst abdomen Abdominal compartment syndrome Fistula Intra-abdominal bleeding Intra-abdominal hematoma needing surgical evacuation Perforation of visceral organ confirmed at surgery Anastomotic leakage Ischemia or necrosis of a visceral organ Enterostomy dysfunction due to prolapse, stenosis, or retraction Gastric or duodenal ulcer bleeding needing intervention of any type

Secondary Outcome Measures

Mortality at 30, 90 days and 1 year
Mortality
Quality of life after treatment
Quality of life is measured after 3 and 12 months by the short form health survey (SF-36) questionnaire. The scale measures overall health status. SF-36 consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability. Following eight sections are included: vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning, mental health.
Ventral hernia rate
Ventral hernia after after 12 months assessed by clinical examination and abdominal CT-scan with intravenous contrast +/- Valsalva maneuvre.
Hospital care utility within three months after index surgery
Three months after the index operation, a record review will be made to estimate the health care utility and includes surgeries, total hospital stay, admissions at the ICU, and radiological interventions

Full Information

First Posted
April 25, 2019
Last Updated
January 19, 2022
Sponsor
Odense University Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT03932461
Brief Title
Vacuum Assisted Closure Versus On-demand Relaparotomy in Patients With Fecal or Diffuse Peritonitis
Acronym
VACOR
Official Title
Vacuum Assisted Closure Versus On-demand Relaparotomy in Patients With Fecal or Diffuse Peritonitis: A Multicenter Randomized Controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
January 2022
Overall Recruitment Status
Recruiting
Study Start Date
June 1, 2020 (Actual)
Primary Completion Date
September 1, 2023 (Anticipated)
Study Completion Date
September 1, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Odense University Hospital

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Multicenter randomized controlled trial including patients with fecal or diffuse peritonitis to either vacuum assisted closure or relaparotomy "on-demand".
Detailed Description
Multicenter randomized controlled trial including patients with fecal or diffuse peritonitis* to either vacuum assisted closure or relaparotomy "on-demand". The aim with our study is to compare the postoperative complications between vacuum assisted closure and relaparotomy "on-demand". Primary endpoint is to compare peritonitis related complications and Comprehensive Complication Index (CCI) between NPWT treatment (VAC) and conventional treatment (ROD) at 30, 90 days and 1 year. Secondary outcome parameters are: Mortality at 30, 90 days and 1 year, SOFA score and C-reactive protein measured the first seven days after index laparatomy, quality of life after 3 and 12 months (SF-36 questionnaire), ventral hernia after 3 and 12 months. (assessed by CT) and, hospital care utility within three months after index surgery. A power calculation was made which concluded that 340 patients should be included. *Diffuse fecal peritonitis is defined as contamination of 2 out of the 4 abdominal quadrants with fecal contamination starting from the small intestine, colon or rectum. Design A multicenter non-blinded superiority randomized controlled trial on VAC vs. ROD. Danish, as well as other European centers, will be invited to participate All patients over 18 with suspected diffuse peritonitis caused by perforation of the small intestine, colon or rectum with contamination in minimum 2 out of 4 abdominal quadrants, will be included. Exclusion criteria are; Diffuse peritonitis originating from a different focus than the small intestine, colon or rectum Diffuse peritonitis originating from a perforation on the stomach, duodenum, gallbladder, appendix, necrotizing pancreatitis, salpingitis, or peritoneal dialysis Primary peritonitis Immunocompromised (ongoing chemotherapy or prednisolone >20 mg/day) Chronic parenchymal liver disease Pregnancy Patients with end-stage disease Laparoscopic surgery (not converted to laparotomy) Acute occlusion of superior mesenteric artery Peritoneal carcinomatosis Abdominal trauma Lack of consent from the surgical equipoise Local peritonitis confined to 1 quadrant only Randomization Patients are included by a surgical equipoise followed by patient information and consent after recovery. The primary investigator from each site will be contacted by the surgeon on-call when a patient is scheduled for diagnostic laparoscopy or explorative laparotomy on suspicion of secondary peritonitis. Patients' fulling inclusions criteria will be randomized after consent has been obtained by the surgical equipoise. Centers that do not receive approval from their respective scientific ethics committee to include patients through a surgical equipoise must obtain informed and written consent before randomization. Randomization will be web-based via (REDCap ®) in blocks of 2, 4, and 6 stratified for center and age above or below 65 years. The justifications for stratifying according to the center are that there might be differences in the surgical treatment, preoperative optimization, and postoperative treatment both at the ward and intensive care unit (ICU) that might affect the outcome. The patients will be randomized to either abdominal closure with ROD or open abdomen with VAC. The randomization tool, along with eligibility criteria, can be accessed through our website, www.vacor.sdu.dk. In cases where the surgeon finds that the allocated treatment may be contraindicated or is judged to harm the patient, it will be left to the surgeon's discretion to choose the most appropriate treatment. Patients who cannot be treated according to randomization will be analyzed according to intention-to-treat principles. Any eligible patient not included will be registered in a screening log. How to apply Vacuum Assisted Closure (VAC) The VAC® Abdominal Dressing System (KCI Vacuum Assisted Closure, San Antonio, TX, USA) will be used. Intestines, including lateral aspects, are covered by the visceral protective layer. The first layer of foam is placed in the laparostoma on the visceral protective layer and must extend below the fascia at a distance of 5 cm from the facial opening. Above this, a minimum of one piece of foam is folded and placed in the laparostoma. Finally, the laparostoma will be covered by the occlusive drape. A circular opening of approximately 5 cm in diameter will be created in the drape where the connection tubes to the vacuum pump will be placed. Simultaneously while applying the negative pressure of 125 mmHg, the wound edges are approximated manually towards the midline. The dressing will be changed with an interval of approximately 48 hours as standard or whenever needed according to the clinical condition. Each dressing change must be performed in the operation theatre with the patient in general anesthesia and muscle relaxation. Peritoneal fluid must be cultured at each dressing change and when fascia is closed. The fascia closure will commence as soon as possible according to the patient's general condition judged by gastrointestinal function, renal function, and a decline in inflammatory parameters either in one or repeated sessions. The aim will be a closure of the abdomen within a maximum of 8 days after the index operation. The fascia closure after VAC-treatment can be according to the Israelssons principle as described below or upon the surgeon's discretion. A staged closure may start distally, proximally, or in a combination. How to do primary closure The abdominal wall is closed according to the Isreaelsson principle where it is sewn continuously in the fascia at a distance between the sutures of 5 mm and the distance to the facade edge of 5-10 mm. Monofilament PDS 0-0 (Ethicon) (or equivalent) is used. The suturing is started cranially and caudally, and the sutures are tied at the end of the continuous thread with self-locking knots. 4 times as much suture material as the length of the wound must be consumed. The fascia closure after VAC-treatment can be according to the Israelssons principle as described below or upon the surgeon's discretion. A staged closure may start distally, proximally, or in a combination. Postoperative course Immediately after index operation, the surgeon fills out the baseline form containing patient characteristics and comorbidities, etiology of the peritonitis, surgical procedure, and the complexity of the condition according to Björck's classification. Patients can be transferred postoperatively to the intensive care unit (ICU) or the ward at the discretion of the treating team. Upon arrival to either the ward or the ICU, Acute Physiology and Chronic Health Evaluation II (APACHE II) and sequential organ failure assessment (SOFA) score must be performed by the attending anesthesiologist. SOFA-scoring and routine blood samples with CRP, bilirubin, creatinine, and platelets must be performed daily within the first seven days after index operation. Discharge from the ICU will be at the discretion of the attending intensivist and surgeon. After completion of treatment At hospital discharge, the patients will be booked for follow-up after 12 months in the outpatient clinic for abdominal palpation and abdominal CT-scan with intravenous contrast and Valsalva maneuver. In addition, the SF-36 questionnaire will be completed at 3- and 12-months follow-up. Power calculation With an expected peritonitis related complications rate of 40% in the ROD group and 25% in the VAC group, the desired power of 80%, a significance level of 0.05, and an expected drop-out of 5% a total of 340 patients should be included. With this sample size a 0.32 standard deviation difference in mean CCI between the two groups could be detected with 80% as well. To ensure sufficient recruitment, the study will be multicentre and European. Eight active centers have been included, and two are in process. Randomization tools along with eligibility criteria are accessible through our website. The workflow and relevant contact details appear on posters at the participating departments. Study progress will be available on the website. Statistical analysis Patient characteristics will be summarized with frequencies and proportions (for categorical variables) or with mean values ± standard deviation, median values, quartiles, and minimum and maximum values (for numerical variables). Categorical variables will be compared using a Fisher's exact test and continuous variables with a Wilcoxon rank-sum test. The primary peritonitis-related complication outcome will be compared between intervention groups by chi-squared test, reported as relative risk with 95% CI. The CCI outcome will be compared by linear regression with bootstrapped standard errors reporting mean difference with 95% confidence intervals. A superiority and a non-inferiority analysis VAC treatment against primary closure with ROD will be performed. Applying non-inferiority margin of 5% of the peritonitis related complications. An univariate analysis will be performed on the individual complication types (abscess, leakage, etc.) and complications as a whole (peritonitis related complications and CCI). Fisher's exact or chi-square test will be used to compare the treatments depending on the number of observations. Adjusted analysis by logistic regression will be performed for complications as a whole and for the individual complications as an outcome, where it will be adjusted for age, performance status, and comorbidity. The above analyses will also be performed as a subgroup analysis where patients with APACHE-II score> ten will be included. This evaluates VAC and ROD in the most seriously ill part of the patient population. The hospital health care utility and average treatment costs are compared between the treatment groups. The resource use will be reported as the mean difference with 95% confidence intervals (CI) compared by linear regression. In case of deviations from normality assumptions, bootstrapping with 1000 repetitions will be performed. Finally, the proportion of patients who experience radiological, acute operations will be compared by binomial regression estimating relative risk (RR) with 95% CI. The interim analysis will be performed at 25%, 50%, and 75% of recruited patients on the primary outcome after 30-days to detect significant differences between groups at the earliest possible time, ultimately leading to the termination of the study. We have adjusted our power calculation to the interim analyses using the O'Brian-Flemming method. The study group will have access to the results of the interim analyses and may make the final decision to terminate the study. All of the above analyses will be performed as both intention-to-treat (patients will be analyzed according to their randomization group) and per-protocol analysis (what actually happened). The main analyses will be performed as complete case analyses. Multiple imputations will impute missing values in a supplementary analysis, including baseline characteristics as predictors. P values less than 0.05 will be considered statistically significant. Statistical calculations will be performed using Stata software (version 15, Stata Corp LP, Texas, USA). Ethics The study will be conducted in accordance with the Declaration of Helsinki and complies with current GDPR recommendations. The regional Danish Medical Ethics committee has approved the study to include patients in the acute setting with temporary consent by a surgical equipoise followed by patient information and consent after recovery. The surgical equipoise must not have any personal interest in the experiment, have experience, or have knowledge about the disease and the risks and benefits of the treatments and be indifferent to the therapeutic value of the two interventions. The rationale for choosing this inclusion model was that the subjects require immediate surgical intervention, are partly or entirely incapable of receiving and understanding the information. The severity of the condition does not allow time for third-party authorization. Both treatment regimens are accepted, safe, and widely used for this patient group. After the convalescence, patients will be informed about the project, and consent will be obtained. In instances where the patients do not survive before regaining habitual state, surrogate consent will be obtained. The patient can withdraw from the experiment at any time without having to explain him- or herself. Patients in Denmark are covered by national insurance (Patienterstatningen), international centers will use country-specific insurance regulations. The study is investigator-initiated without economic interest to manufacturers or others involved in the investigation. No financial resources will be provided to the trial participants. Participating centers will receive the amount of 4000 Danish Krone per included patient yearly to cover the CT-scan of the abdomen and follow-up at the outpatient clinic. The final data set will be available to the project owner and data assessor. Data can be shared in an anonymized form after an approved agreement on request. The primary investigator is responsible for data collection and handling. Unexpected adverse events must be reported to the regional committee of ethics.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Fecal Peritonitis, Secondary Peritonitis, Diffuse; Peritonitis

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
Multicentre randomized non-blinded clinical trial comprising of > 4 centres. In total there will be included 320 patients.
Masking
None (Open Label)
Allocation
Randomized
Enrollment
340 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Vacuum assisted closure
Arm Type
Active Comparator
Arm Description
The VAC® Abdominal Dressing System (KCI Vacuum Assisted Closure, San Antonio, TX, USA) will be used. Intestines, including lateral aspects, are covered by the visceral protective layer. The first layer of foam is placed in the laparostoma on the visceral protective layer and must extend below the fascia at a distance of 5 cm from the facial opening. Above this, a minimum of one piece of foam is folded and placed in the laparostoma. Finally, the laparostoma will be covered by the occlusive drape. A circular opening of approximately 5 cm in diameter will be created in the drape where the connection tubes to the vacuum pump will be placed. Simultaneously while applying the negative pressure of 125 mmHg, the wound edges are approximated manually towards the midline. Each dressing change must be performed in the operation theatre with the patient in general anesthesia and muscle relaxation.
Arm Title
Relaparotomy "on-demand"
Arm Type
Active Comparator
Arm Description
The Isreaelsson principle includes a running suture of the fascia with a distance of 5 mm between the stitches of 5 mm and the distance to the facial edge of 5-10 mm. Monofilament PDS 2-0 or equivalent is used. The suturing is started cranially and caudally, and the sutures are tied with self-locking knots. Four times as much suture material as the length of the wound must be used. The peritoneal fluid must be cultured at closure. The treating surgeon decides to perform a ROD and should be guided by the patient's general condition, gastrointestinal function, renal function, and inflammatory parameters at daily rounds.
Intervention Type
Procedure
Intervention Name(s)
Vacuum assisted closure
Other Intervention Name(s)
VAC® Abdominal Dressing System, KCI, (San Antonio, TX)
Intervention Description
The Vacuum assisted closure system consists of an abdominal dressing covering the intra abdominal viscera over the dressing there will be placed a blue sponge which will be covered by drape and connected to a vacuum pump.
Intervention Type
Procedure
Intervention Name(s)
Relaparotomy "on demand"
Intervention Description
Abdomen is closed at the index operation after source of peritonitis is treated. Every 48-hours the patients are evaluated for the need of relaparotomy based on clinical and paraclinical parameters.
Primary Outcome Measure Information:
Title
Primary endpoint is to compare peritonitis related complications and Comprehensive Complication Index (CCI) between NPWT treatment (VAC) and conventional treatment (ROD) at 30, 90 days and 1 year.
Description
Disease-Related Major Morbidity Needing Readmission and Conservative Treatment but Not Surgery Fistula Wound dehiscence/incisional hernia with obstruction Abscess needing percutaneous drainage Renal failure Myocardial infarction Gastric or duodenal bleeding Respiratory failure Urosepsis Disease-Related Major Morbidity Needing Surgical Intervention During First Admission or Readmission Incisional hernia Bowel obstruction or herniation due to intra-abdominal adhesions Burst abdomen Abdominal compartment syndrome Fistula Intra-abdominal bleeding Intra-abdominal hematoma needing surgical evacuation Perforation of visceral organ confirmed at surgery Anastomotic leakage Ischemia or necrosis of a visceral organ Enterostomy dysfunction due to prolapse, stenosis, or retraction Gastric or duodenal ulcer bleeding needing intervention of any type
Time Frame
1 year
Secondary Outcome Measure Information:
Title
Mortality at 30, 90 days and 1 year
Description
Mortality
Time Frame
1 year
Title
Quality of life after treatment
Description
Quality of life is measured after 3 and 12 months by the short form health survey (SF-36) questionnaire. The scale measures overall health status. SF-36 consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability. Following eight sections are included: vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning, mental health.
Time Frame
3 and 12 months
Title
Ventral hernia rate
Description
Ventral hernia after after 12 months assessed by clinical examination and abdominal CT-scan with intravenous contrast +/- Valsalva maneuvre.
Time Frame
3 and 12 months
Title
Hospital care utility within three months after index surgery
Description
Three months after the index operation, a record review will be made to estimate the health care utility and includes surgeries, total hospital stay, admissions at the ICU, and radiological interventions
Time Frame
Up to 12 weeks
Other Pre-specified Outcome Measures:
Title
Microdialysis
Description
The concentration of lactate, glycerol, pyruvate, glucose, and cytokines in the peritoneal fluid in a subgroup of 10 patients from each group measured by intraperitoneal microdialysis postoperative day 0-4
Time Frame
First 4 days afte index laparatomy
Title
Inscional hernia
Description
Incisional hernia rate after three years assessed by a retrospective review of patient records
Time Frame
3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
19 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Patients eligible for enrolment are 18+ years of age and are scheduled for acute laparotomy due to suspected peritonitis originating from perforation of the small bowel, colon, or rectum. To be included, purulent, enteric, or fecal contamination in a minimum of 2 out of 4 quadrants must be confirmed. Exclusion Criteria: Diffuse peritonitis originating from a different focus than the small intestine, colon or rectum Diffuse peritonitis originating from a perforation on the stomach, duodenum, gallbladder, appendix, necrotizing pancreatitis, salpingitis, or peritoneal dialysis Primary peritonitis Immunocompromised (ongoing chemotherapy or prednisolone >20 mg/day) Chronic parenchymal liver disease Pregnancy Patients with end-stage disease Laparoscopic surgery (not converted to laparotomy) Acute occlusion of superior mesenteric artery Peritoneal carcinomatosis Abdominal trauma Lack of consent from the surgical equipoise Local peritonitis confined to 1 quadrant only
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Pooya Rajabaleyan, M.D.
Phone
+4527118889
Email
pooya.r@hotmail.com
First Name & Middle Initial & Last Name or Official Title & Degree
Mark Ellebæk, M.D., Ph.d.
Phone
+4540880511
Email
markep01@gmail.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Niels Qvist, Professor
Organizational Affiliation
Surgical Department A, Odense University Hospital, Denmark
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Uffe Tange Holst, M.D.
Organizational Affiliation
Surgical Department A, Odense University Hospital, Denmark
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Jens Michelsen, M.D.
Organizational Affiliation
Anesthesiology department V, Odense University Hospital, Denmark
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Palle Toft, Professor
Organizational Affiliation
Anesthesiology department V, Odense University Hospital, Denmark
Official's Role
Study Chair
Facility Information:
Facility Name
Odense University Hospital
City
Odense
State/Province
Fyn
ZIP/Postal Code
5000
Country
Denmark
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Pooya Rajabaleyan, M.D.
Phone
+4527118889
Email
pooya.r@hotmail.com
First Name & Middle Initial & Last Name & Degree
Mark Ellebæk, M.D., Ph.d.
Phone
+4540880511
Email
markep01@gmail.com

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
35619144
Citation
Rajabaleyan P, Michelsen J, Tange Holst U, Moller S, Toft P, Luxhoi J, Buyukuslu M, Bohm AM, Borly L, Sandblom G, Kobborg M, Aagaard Poulsen K, Schou Love U, Ovesen S, Grant Solling C, Morch Sondergaard B, Lund Lomholt M, Ritz Moller D, Qvist N, Bremholm Ellebaek M; VACOR study group. Vacuum-assisted closure versus on-demand relaparotomy in patients with secondary peritonitis-the VACOR trial: protocol for a randomised controlled trial. World J Emerg Surg. 2022 May 26;17(1):25. doi: 10.1186/s13017-022-00427-x.
Results Reference
derived

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Vacuum Assisted Closure Versus On-demand Relaparotomy in Patients With Fecal or Diffuse Peritonitis

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