A study to analyse the effect of intra abdominal pressure on the outcome of laparotomies

Completed

Conditions: abdominal conditions that need emergency or elective laparotomy

Registration Number: CTRI/2017/08/009208

Lead Sponsor: Ashwin R

Brief Summary: Introduction:

Intra abdominal pressure affects optimal function of various organ systems. The incidence of overt abdominal compartment syndrome in the post operative period is coming down with advances in intensive care. Eventually, the focus has now shifted to intra abdominal hypertension and its possible deleterious effects. This study analyses the effect of maintaining optimal IAP on outcome of laparotomies.

Materials and Methods:

This is a prospective, interventional study conducted among surgical inpatients planned for elective or emergency laparotomy. Eighty-four patients were enrolled and randomly allotted into two groups A and B. In both the groups, pre-operative and serial post-operative IAP measurements were done. In-group A, IAH was controlled using WCACS protocols. The rate of overall and individual complications was assessed.

Results:

The incidence of IAH in the preoperative period was 21% - 25% among elective laparotomies and 75â€“ 79 % among emergencies. Incidence of post-operative IAH (0 hour value) and eventually at 6, 24 and 48 hours was analysed. The interventions were effective in reducing the intra-abdominal pressure as only two patients with IAH were recorded at the end of 24 hours. There was a significant decrease in overall complication rate (p = 0.029) and abdominal wall complications (p = 0.038). The decrease in the rate of anastomotic leak was not significant.

Conclusion:

The high incidence of perioperative IAH emphasises the need for perioperative IAP monitoring. Maintaining optimal IAP in the post operative period is vital as it reduces post laparotomy complications especially wound and rectus dehiscence and thereby reducing the morbidity.

Detailed Description: Not available

Recruitment & Eligibility

Status: Completed

Sex: All

Target Recruitment: 80

Inclusion Criteria

All patients more than 18 years admitted in surgical wards and planned for emergency/ elective laparotomy.

Exclusion Criteria

1.Patients with pre-existing conditions that prevent insertion of a Foleyâ€™s catheter or pre-existing lesions of urinary bladder.
2.Patients where bladder injury is suspected.
3.Patients where rectus closure is not done in the same sitting.

Study & Design

Study Type: Interventional

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
decreased incidence of post operative complications like wound dehiscence, rectus dehiscence. early detection of secondary peritonitis	early post operative period (within 2 weeks)

Secondary Outcome Measures

Name	Time	Method
decreased morbidity due to laparotomy in study arm	at discharge

Trial Locations

Locations (1): Madurai Medical College
🇮🇳
Madurai, TAMIL NADU, India
Madurai Medical College
🇮🇳Madurai, TAMIL NADU, India
ashwin
Principal investigator
9952409865
ashwin90ster@gmail.com