We analyzed modern treatment methods for widespread peritonitis (laparostomy, «open abdomen») and prospects of this approach. There are no generally accepted methods of laparostomy for peritonitis. Results of systematic reviews are often difficult to be interpreted due to combination of studies with and without control groups, as well as different methodologies for analysis of results. Laparostomy has many advantages. At the same time, patients are at risk of complications such as intestinal fistulas, adhesions (frozen abdomen), intestinal abscesses, delayed wound closure and ventral hernias. «Open abdomen (OA)» method is indicated for abdominal sepsis (septic shock), no control of infection, damage control strategy, extensive abdominal wall defect and significant intestinal paresis, as well as edema leading to compartment syndrome. The risk of intestinal fistulas and other wound complications increases in 7—12 days after laparostomy. In all cases, it is necessary to strive for delayed anterior abdominal wall wound closure as early as possible. There is no clear evidence in favor of «open abdomen» or primary closure with on-demand relaparotomy in patients with secondary peritonitis. Further research is required for new effective and safe devices for temporary abdominal closure, as well as significant evidence and clear indications for open abdomen technique.
Лебедев et al. (Mon,) studied this question.