THE ROLE OF LAPAROTOMIC WOUND INFECTION IN THE FORMATION OF PLANE VISCERAL AND PARIETAL ADHESIONS AND THE DEVELOPMENT OF ABDOMINAL ADHESIVE DISEASE IN THE TREATMENT OF ADVANCED PERITONITIS

The aim is to identify the connection between the presence of peritoneum adhesions and the laparotomic wound healing, as well as to find a way to prevent the adhesive disease.

Materials and methods. The treatment of 149 patients with purulent peritonitis in the main and control groups was performed. In the main group, the laparotomic wounds were sutured by removable draining muscular aponeurotic sutures. In the control group, the laparotomic wounds were sutured with monofilament interrupted sutures in layers, with the edges of the dissected peritoneum being seized into the aponeurotic suture.

Results. The suppurations of laparotomic wounds in the control group were 34.7%. In the main group, where the laparotomic wounds were sutured with removable draining muscular aponeurotic sutures (RDMAS), the suppuration occurred only in one patient (2.2%). The abdominal adhesive disease was observed in 19.4% cases in the control group, with 4 patients (2.0%) having been operated. In the main group, only 2 cases (4.3%) of the abdominal adhesive disease treated without surgical intervention were detected.

Conclusion. One of the main causes of the postoperative abdominal adhesive disease with advanced peritonitis is the suppuration of the laparotomic wound. The use of RDMAS during the surgical treatment of advanced purulent peritonitis not only prevents the suppuration of laparotomic wounds, but also significantly reduces the development of all types of adhesive disease caused by visceral and parietal peritoneal adhesions.

Conflict of interest: the authors declare no conflict of interest.