Hellenic Journal of Surgery
Beneficial Effect of Hyperbaric Oxygen Therapy
on an Open Abdominal Laparostomy Wound
Hellenic Journal of Surgery (2018) 90:2, 90-92
PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India
Corresponding author: Sourav Sarkar M.S. (General Surgery)
Senior Resident, Department of Surgery
PGIMER & Dr RML Hospital, New Delhi 110001, India
Tel: +919968737665, e-mail: firstname.lastname@example.org
Received Dec 2, 2017; Accepted Feb 1, 2018
Hyperbaric oxygen therapy (HBOT) is the use of 100%
oxygen at pressures greater than atmospheric pressure.
HBOT has been successfully used as adjunctive therapy
for wound healing. Non-healing wounds, such as diabetic
and vascular insufficiency ulcers, have been a major area
of study for hyperbaric physicians. The use of HBOT as
an adjunct has been approved in such cases, following
success in various studies and trials. HBOT is indicated
also for infected wounds, including those with clostridial
myonecrosis, necrotising soft tissue infections and Fournier's
gangrene, and for traumatic wounds, crush injury, compart-
ment syndrome, compromised skin grafts and flaps and
thermal burns .To date there has been no report of the
effect of HBOT on open abdominal wounds. We treated
a patient with an extensive open laparostomy with HBOT
and observed very good results.
A 50-year-old female presented at the emergency surgi-
cal department with a bile-stained discharge from the port
site of a laparoscopic cholecystectomy performed 4 days
previously. She had tachycardia, with signs of peritonitis
and a raised white blood cell count (WBC).
Bile duct injury following the laparoscopic cholecys-
tectomy was suspected, but magnetic resonance cholan-
giopancreatography (MRCP) showed no bile duct injury
or leakage. Chest X-ray showed gas under the diaphragm.
Exploratory laparotomy under general anesthesia revealed
two perforations in the ileum, 6 inches apart, 3 feet proximal
to ileocecal junction. An ileostomy was constructed and
the abdomen was left open, because the whole bowel was
edematous and closure of the abdomen was not feasible.
A Bogota bag was placed over the bowel to cover the lapa-
rostomy wound (Figure 1).
The patient was transferred to the intensive care unit
Hyperbaric oxygen therapy (HBOT) is the exposure to 100% oxygen at pressures greater than at-
mospheric pressure. Currently there are several approved applications, and indications for the use of HBOT are
increasing. HBOT has been successfully used as adjunctive therapy for wound healing.
A 50-year-old female presented at the surgical emergency department with bile-stained discharge
from the port site of a laparoscopic cholecystectomy performed 4 days previously. Exploratory laparotomy revealed
two perforations in the ileum and edema of the bowel. An ileostomy was constructed, but the abdomen was not
closed because of the edematous bowel, and a Bogota bag was placed over the bowel to cover the laparostomy. The
abdominal wound was extensive, with exposed loops of bowel. When the wound failed to heal, HBOT was first
given on the 10
post-operative day (POD). She had a total of 4 sessions of HBOT with 100% oxygen under 2.5
atmospheres absolute pressure for 60 minutes on PODs 10, 12, 14 and 16.
Healthy granulation tissue started appearing over the bowel and wound edges, and impressive wound heal-
ing occurred with only 4 60-minute sessions of HBOT. The patient was discharged on POD 20.
The application of HBOT for cases of burst abdomen has not been previously documented. This is the
first report of its beneficial effect in a single case with an extensive open laparostomy wound. Further studies need
to be conducted in order to confirm the therapeutic effect of HBOT on open abdominal wounds.
Hyperbaric oxygen therapy (HBOT); laparostomy; open abdomen; post-operative Day (POD)