Features of the se lection and implementation of surgical tactics in gunshot peritonitis

The OBJECTIVE was to substantiate the algorithm for selecting and implementing surgical tactics for gunshot peritonitis (GP) taking into account the characteristics of its clinical course.

METHODS AND MATERIALS. The results of treatment of 472 victims with gunshot wounds to the abdomen were analyzed. As part of the tactics of multi-stage surgical treatment, modern techniques were used: vacuum-assisted and vacuum-instillation laparostomy (VAL and VIL), while the choice of indications was carried out using the peritonitis progression risk scale developed in the clinic.

RESULTS. The frequency of postoperative complications was 43.8 %, and hospital mortality was 4.9 %. At the same time, in 45 % of cases, the trigger factors for thanatogenesis were complications associated with defects in surgical treatment at previous stages. The progression of peritonitis with the development of abdominal sepsis against the background of the treatment carried out in the clinic was noted only in 8 % of cases. The incidence of unformed intestinal fistulas was 9.8 %, and with VIL this figure was significantly lower than with VAL: 2.4 % versus 12.1 % (p=0.06). In addition, the use of VIL was accompanied by a more rapid elimination of pathogenic microflora and a less pronounced adhesive process.

CONCLUSION. The relief of GP requires multi-stage surgical treatment. The key to its successful implementation is compliance with uniform tactical approaches, as well as the use of an effective technique for temporary closure of the abdominal cavity. The original scale of the risk of peritonitis progression provides a reasonable approach to laparostomy, with VIL being the most preferable option.

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