Role of zipper in the management of abdominal sepsis.

Background: Continuous peritoneal lavage, staged laparotomies and radical peritoneal debridement have been used to reduce mortality from severe abdominal sepsis. Recently, open abdomen technique using a 'zipper' with or without mesh for abdominal lavage has shown promising results.

Aims: To evaluate open abdominal technique using a zipper in patients with advanced diffuse peritonitis with impending or established multiple organ failure.

Methods: Modified open abdomen technique using zipper with or without mesh was used for abdominal closure in eight patients with severe generalized peritonitis (APACHE-II score range 27-30).

Results: Zipper was inserted at first laparotomy in three patients, at second exploration in four and at the time of third laparotomy in one case. Two patients required strips of mesh in addition to zipper. Six of eight patients survived and were discharged after an average period of 27 days. Two deaths were due to multisystem organ failure. In four patients additional surgical procedures like closure of perforation, temporary ileostomy and resection anastomosis of small bowel was carried out through the zipper. Zipper-mesh were removed an average of 10.5 days after insertion. Three patients developed incisional hernia at 6 months follow-up.

Conclusion: This technique merits further controlled trials to ascertain its indications and benefits.