Vacuum-assisted closure versus on-demand relaparotomy in patients with secondary peritonitis-the VACOR trial: protocol for a randomised controlled trial

Pooya Rajabaleyan, Jens Michelsen, Uffe Tange Holst, Sören Möller, Palle Toft, Jan Luxhøi, Musa Buyukuslu, Aske Mathias Bohm, Lars Borly, Gabriel Sandblom, Martin Kobborg, Kristian Aagaard Poulsen, Uffe Schou Løve, Sophie Ovesen, Christoffer Grant Sølling, Birgitte Mørch Søndergaard, Marianne Lund Lomholt, Dorthe Ritz Møller, Niels Qvist, Mark Bremholm Ellebæk, VACOR study group, Jens Michelsen, Uffe Tange Holst, Sören Möller, Palle Toft, Jan Luxhøi, Musa Buyukuslu, Aske Mathias Bohm, Lars Borly, Gabriel Sandblom, Martin Kobborg, Kristian Aagaard Poulsen, Uffe Schou Løve, Sophie Ovesen, Christoffer Grant Sølling, Birgitte Mørch Søndergaard, Marianne Lund Lomholt, Dorthe Ritz Møller, Niels Qvist, Mark Bremholm Ellebæk, Pooya Rajabaleyan, Jens Michelsen, Uffe Tange Holst, Sören Möller, Palle Toft, Jan Luxhøi, Musa Buyukuslu, Aske Mathias Bohm, Lars Borly, Gabriel Sandblom, Martin Kobborg, Kristian Aagaard Poulsen, Uffe Schou Løve, Sophie Ovesen, Christoffer Grant Sølling, Birgitte Mørch Søndergaard, Marianne Lund Lomholt, Dorthe Ritz Møller, Niels Qvist, Mark Bremholm Ellebæk, VACOR study group, Jens Michelsen, Uffe Tange Holst, Sören Möller, Palle Toft, Jan Luxhøi, Musa Buyukuslu, Aske Mathias Bohm, Lars Borly, Gabriel Sandblom, Martin Kobborg, Kristian Aagaard Poulsen, Uffe Schou Løve, Sophie Ovesen, Christoffer Grant Sølling, Birgitte Mørch Søndergaard, Marianne Lund Lomholt, Dorthe Ritz Møller, Niels Qvist, Mark Bremholm Ellebæk

Abstract

Background: Secondary peritonitis is a severe condition with a 20-32% reported mortality. The accepted treatment modalities are vacuum-assisted closure (VAC) or primary closure with relaparotomy on-demand (ROD). However, no randomised controlled trial has been completed to compare the two methods potential benefits and disadvantages.

Methods: This study will be a randomised controlled multicentre trial, including patients aged 18 years or older with purulent or faecal peritonitis confined to at least two of the four abdominal quadrants originating from the small intestine, colon, or rectum. Randomisation will be web-based to either primary closure with ROD or VAC in blocks of 2, 4, and 6. The primary endpoint is peritonitis-related complications within 30 or 90 days and one year after index operation. Secondary outcomes are comprehensive complication index (CCI) and mortality after 30 or 90 days and one year; quality of life assessment by (SF-36) after three and 12 months, the development of incisional hernia after 12 months assessed by clinical examination and CT-scanning and healthcare resource utilisation. With an estimated superiority of 15% in the primary outcome for VAC, 340 patients must be included. Hospitals in Denmark and Europe will be invited to participate.

Discussion: There is no robust evidence for choosing either open abdomen with VAC treatment or primary closure with relaparotomy on-demand in patients with secondary peritonitis. The present study has the potential to answer this important clinical question.

Trial registration: The study protocol has been registered at clinicaltrials.gov (NCT03932461). Protocol version 1.0, 9 January 2022.

Keywords: Faecal peritonitis; Primary abdominal closure; Relaparotomy on-demand; Secondary peritonitis; Vacuum-assisted closure.

Conflict of interest statement

The primary investigator and collaborators have no financial interest in the trial.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart of inclusion and obtaining consent by the surgical equipoise
Fig. 2
Fig. 2
CONSORT flow diagram
Fig. 3
Fig. 3
Participant timeline

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