TY - JOUR A1 - Willms, A. G. A1 - Schwab, R. A1 - von Websky, M. W. A1 - Berrevoet, F. A1 - Tartaglia, D. A1 - Sörelius, K. A1 - Fortelny, R. H. A1 - Björck, M. A1 - Monchal, T. A1 - Brennfleck, F. A1 - Bulian, D. A1 - Beltzer, C. A1 - Germer, C. T. A1 - Lock, J. F. T1 - Factors influencing the fascial closure rate after open abdomen treatment: Results from the European Hernia Society (EuraHS) Registry. Surgical technique matters JF - Hernia N2 - Purpose Definitive fascial closure is an essential treatment objective after open abdomen treatment and mitigates morbidity and mortality. There is a paucity of evidence on factors that promote or prevent definitive fascial closure. Methods A multi-center multivariable analysis of data from the Open Abdomen Route of the European Hernia Society included all cases between 1 May 2015 and 31 December 2019. Different treatment elements, i.e. the use of a visceral protective layer, negative-pressure wound therapy and dynamic closure techniques, as well as patient characteristics were included in the multivariable analysis. The study was registered in the International Clinical Trials Registry Platform via the German Registry for Clinical Trials (DRK00021719). Results Data were included from 630 patients from eleven surgical departments in six European countries. Indications for OAT were peritonitis (46%), abdominal compartment syndrome (20.5%), burst abdomen (11.3%), abdominal trauma (9%), and other conditions (13.2%). The overall definitive fascial closure rate was 57.5% in the intention-to-treat analysis and 71% in the per-protocol analysis. The multivariable analysis showed a positive correlation of negative-pressure wound therapy (odds ratio: 2.496, p < 0.001) and dynamic closure techniques (odds ratio: 2.687, p < 0.001) with fascial closure and a negative correlation of intra-abdominal contamination (odds ratio: 0.630, p = 0.029) and the number of surgical procedures before OAT (odds ratio: 0.740, p = 0.005) with DFC. Conclusion The clinical course and prognosis of open abdomen treatment can significantly be improved by the use of treatment elements such as negative-pressure wound therapy and dynamic closure techniques, which are associated with definitive fascial closure. KW - open abdomen KW - peritonitis KW - fascial closure KW - hernia KW - abdominal compartment syndrome KW - abdominal trauma KW - burst abdomen KW - NPWT KW - VAC Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-234871 SN - 1265-4906 VL - 26 IS - 1 ER - TY - THES A1 - Reinthal, Sirje T1 - Adjuvante Therapiestrategien bei der Behandlung intraabdomineller Infektionen : Ergebnisevaluierung einer deutschen Multicenterstudie T1 - Additional strategies in treatment of intraabdominal infections. Result evaluation of a german multicenter study N2 - Fragestellung: Welchen Nutzen bringt eine adjuvante Therapie mit intravenösem Immunglobulin bezüglich des Krankheitsverlaufs bei intraabdominellen Infektionen? Material und Methode: 71 Patienten mit intraabdominellen Infektionen wurden mit Immunglobulin oder Placebo behandelt. Verschiedene Score-Systeme wurden für die Auswertung des Schweregrades der Krankheit verwendet. Ergebnisse: Die Gesamtanalyse der Daten zeigt, daß Patienten mit Peritonitis von einer Behandlung mit Immunglobulin profitieren können. Zusammenfassung: Eine zusätzliche Gabe von Immunglobulin kann einen nützlichen Effekt für den Verlauf intraabdomineller Infektionen haben. N2 - Inquiry: Is the supplementary treatment with intravenous immunoglobulin beneficial regarding course of intraabdominal infections? Material and methods: 71 patients with intraabdominal infections were treated with immunoglobulin or placebo. Different scores as a well known measure of illness severity were used. Results: The entire analysis of data show a possible profit for patients with peritonitis who are treated with immunoglobulin. Conclusion: Additive dose of immunoglobulin may have a beneficial effect on the course of intraabdominal infection. KW - Peritonitis KW - Infektion KW - Intravenös KW - Immunglobulin KW - peritonitis KW - infection KW - intravenous KW - immunoglobulin Y1 - 2005 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-14460 ER - TY - THES A1 - Eisoldt, Stefan T1 - Additive Therapie der intraabdominellen Infektion - Ergebnisevaluierung einer deutschen Multicenterstudie T1 - Additive therapy of intraabdominell infections - Evaluation of a german multicentre study N2 - Diese multizentrische, randomisierte, doppel-blinde Studie hatte zum Ziel, die additive Wirksamkeit von Pentaglobin® bei der Behandlung der Peritonitis zu untersuchen. Pentaglobin® wurde hierbei zusammen mit einer im klinischen Alltag üblichen Antibiotikatherapie intravenös verabreicht. Die Kontrollgruppe erhielt ein Placebo bestehend aus Humanalbumin. Primäre Endpunkte waren der postoperative kumulierte Summenwert der SIRS-Kriterien nach Bone bis zum 23. postoperativen Tag sowie der postoperative kumulierte Summenwert des SOFA-Score bis zum 28. postoperativen Tag. Ergebnisse wurden durch Anwendung verschiedener Scores überprüft. Insgesamt konnten 260 Patienten mit Peritonitis an 16 Studienzentren eingeschlossen werden. 258 Patienten kamen in die Safety-Analyse sowie 255 in die Intentio-To-Treat Analyse. Bei den primären Endpunkten konnte eine Tendenz für die Wirksamkeit von Pentaglobin® bei septischen Patienten gezeigt werden. Insbesondere die Patienten mit einem höheren MPI-Wert scheinen mehr von einer Therapie mit Pentaglobin® profitiert zu haben. Eine statistische Signifikanz konnte jedoch nicht nachgewiesen werden. Bei den sekundären Endpunkten zeigte sich eine statistisch signifikant kürzere Therapie mit Katecholaminen in der Pentaglobin®-Gruppe. Weiterhin fanden sich statistisch signifikante Unterschiede des IL-2-Rezeptors sowie des TNF-1-Rezeptors im Studienverlauf zwischen der Pentaglobin®- und der Placebo-Gruppe. Bei der Überprüfung der Verträglichkeit der Studienmedikation fanden sich keine signifikanten Unterschiede. N2 - The aim of the present clinical trial was to show a therapeutic effect of Pentaglobin® under concomitant administration of antibiotics in patients with beginning peritoneal infections. The study was conducted as a placebo-controlled, double-blind, multicentre and prospective trial of clinical phase IV. The patients were allocated to the two treatment groups (Pentaglobin®/placebo) by randomisation. The primary efficacy parameters were the post-operative cumulative sum score of the SIRS criteria according to Bone until Day 23 and the post-operative cumulative Sequential Organ Failure Assessment (SOFA) sum score until Day 28. In total 260 patients with beginning intraabdominell infection in 16 study centres were included in the study. 258 patients were included in the safety analyses and 255 in the Intention-to-treat analyses. In conclusion, the efficacy results in this study showed a tendency in favour of Pentaglobin® compared to placebo regarding the primary efficacy parameters cumulative SIRS score and cumulative SOFA score that were lower in the Pentaglobin® group than in the placebo group, especially in patients with a more severe peritonitis. The differences between Pentaglobin® and placebo in SIRS and SOFA score were not statistically significant, but patients in the Pentaglobin® group had a lower mean TISS-28 score, a shorter duration of fever, a shorter duration of ICU treatment and artificial ventilation and the duration of treatment with catecholamines was significantly shorter in the Pentaglobin® group. Regarding laboratory parameters, the inflammatory parameters decreased more in the Pentaglobin® group than in the placebo group (with significant differences in favour of Pentaglobin® for IL-2R and TNF-R1) while the significant differences in favour of Pentaglobin® for IgM, IgA, IgG were mainly caused by the administration of the intravenous immunoglobulin preparation (with significant differences in favour of Pentaglobin® for IgM, IgA, IgG). The safety data showed that Pentaglobin® and placebo were equally safe and well tolerated. KW - Randomisierung KW - Kontrollierte klinische Studie KW - Bauchfellentzündung KW - Sepsis KW - Pentaglobin KW - multizentrisch KW - doppel-blind KW - placebo-kontrolliert KW - SOFA KW - SIRS KW - peritonitis KW - sepsis KW - pentaglobin KW - randomised double-blind study Y1 - 2007 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-24660 ER -