INTRA-ABDOMINAL PRESSURE DURING LAPAROTOMY WOUND EDGE REDUCTION AS A PROGNOTIC SIGN OF THE INTRA-ABDOMINAL HYPERTENSION DEVELOPMENT

The purpose – to study the relationship between the level of intra- abdominal pressure (IAP) in the preoperative period, during surgery and during the early postoperative period, in patients with acute intestinal obstruction (AIO) and acute disseminated peritonitis (ADP). Material and Methods. The study of intra- abdominal pressure was conducted in 23 patients with acute intestinal obstruction and 18 patients with acute widespread peritonitis who did not have a temporary colostomy. In these patients, additional IAP measurements were performed immediately before surgery and immediately after suturing the edges of the muscular- aponeurotic layer of the laparotomic wound. The IAP level was measured through the bladder, with a frequency of 2-3 times a day. A correlationregression analysis of the relationships between IAP levels after suturing the edges of the muscular- aponeurotic layer and in the early postoperative period, as well as between IAP levels before surgery and in the early postoperative period, was performed. Results. The IAP level in AIO, determined before surgery, as well as after suturing the edges of the muscular- aponeurotic layer of the laparotomic wound, has a similar nature of correlation with the indicators of the early postoperative period. However, the IAP level determined immediately before surgery, has a relatively stronger correlation with the indicators of the early postoperative period. In ADP, the IAP value, determined in the preoperative period, as well as after suturing the edges of the muscular- aponeurotic layer of the laparotomic wound, has the same strength of correlation with the indicators of the early postoperative period. The results of the study demonstrate the presence of strong direct correlations between the level of IAP determined before the surgical intervention, during the simulation of the closure of the laparotomy wound, and the indicators of the early postoperative period. This allows, for the purpose of prognosis, to focus on the level of IAP, especially determined immediately before the surgical intervention, since it more accurately corresponds to the picture of the early postoperative period. In addition, the simulation of the closure of the laparotomy wound and the determination of the value of IAP during the operation causes certain technical difficulties and inconveniences. Conclusion. There are strong direct correlations between the level of intra- abdominal pressure determined before surgery, during the simulation of laparotomy wound closure, and during the early postoperative period, which allows predicting the development of intra- abdominal hypertension in the early postoperative period.