Management of refractory ascites using NPWT. A pilot study

Several studies have suggested that the ability to control ascites may be a prognostic factor on morbidity and mortality. The ascites flow through the scar of the abdominal wall presents a high risk of infection and makes the healing of the abdominal wound highly challenging. NPWT (negative pressure wound therapy) has been show to accelerate the wound healing in other surgical situations.

We assess the impact of postoperative use of NPWT after hepatectomy in cirrhotic patients on ascites flow.

Methods

This is randomized, prospective, unicentric study, conducted from March 2018 to October 2018. In each group we compare the time needed to durably dry out the ascites flow using NPWT and conventional management.

Results

The post-operative course was marked by ascites without liver failure; the quantity at day 4 was 1100 ml. They were managed with diuretic agents and NPWT was used directly on the skin. The dressing was changed at least every 4 days, depending on the tolerance and the evolution of the skin healing.The NPWT allowed to stop the fluid ascites and yielded complete wound healing after 5 days on average. None of the 5 patients developed ascites infection. One month later a CT-scan was performed on all patients; none of them showed ascites.

Conclusion

NPWT allowed faster surgical wound healing. Medical management of ascites could be optimized and risk of ascites infection might be reduced.

Romane Hurel et al.
Centre Hospitalier Universitaire Reims, General and digestive surgery, Reims, France

Partial list

1. Chan K-M, Lee C-F, Wu T-J, et al. Adverse outcomes in patients with postoperative ascites after liver resection for hepatocellular carcinoma. World J Surg. 2012;36:392–400.

2. Scalise A, Calamita R, Tartaglione C, et al. Improving wound healing and preventing surgical site complications of closed surgical incisions: a possible role of Incisional Negative Pressure Wound Therapy. A systematic review of the literature. Int Wound J. 2016;13:1260–1281