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Transpl Int. 2011 Mar;24(3):e23-7. doi: 10.1111/j.1432-2277.2010.01198.x. Epub 2010 Dec 3.

A novel approach to severe acute pancreatitis in sequential liver-kidney transplantation: the first report on the application of VAC therapy.

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1
General Surgery and Organ Transplantation, Hepatobiliary Surgery and Liver Transplant Unit, Azienda Università di Padova, Padova, Italy.

Abstract

This work is the first report of vacuum-assisted closure (VAC) therapy applied as a life-saving surgical treatment for severe acute pancreatitis occurring in a sequential liver- and kidney-transplanted patient who had percutaneous biliary drainage for obstructive "late-onset" jaundice. Surgical exploration with necrosectomy and sequential laparotomies was performed because of increasing intra-abdominal pressure with hemodynamic instability and intra-abdominal multidrug-resistant sepsis, with increasingly difficult abdominal closure. Repeated laparotomies with VAC therapy (applying a continuous negative abdominal pressure) enabled a progressive, successful abdominal decompression, with the clearance of infection and definitive abdominal wound closure. The application of a negative pressure is a novel approach to severe abdominal sepsis and laparostomy management with a view to preventing compartment syndrome and fatal sepsis, and it can lead to complete abdominal wound closure.

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