Results of surgical treatment of patients with postoperative peritonitis
DOI:
https://doi.org/10.11603/2414-4533.2018.1.8860Keywords:
postoperative peritonitis, relaparotomy, abdominal sepsis.Abstract
The aim of the study. To improve the results of surgical treatment of patients with postoperative peritonitis complicated by abdominal sepsis, by improving timely diagnosis and implementation of optimal surgical tactics.
Materials and Methods. In 2010-2017, intraperitoneal complications were diagnosed in 209 (2.4 %) among 8762 patients operated after acute and chronic diseases of the abdominal cavity.
Results and Discussion. Abscesses of the abdominal cavity take place in 142 (67.9 %) cases, generalized peritonitis – 67 (42.1 %) patients. Mini invasive techniques (laparoscopic sanation of abscesses in the abdominal cavity with drainage of abscesses by stylet-catheter under ultrasound guidance) were effective in 129 (61.7 %) cases. Relaparotomy (RL) was performed in 80 (38.3 %) cases. Among them: in patients with generalized postoperative peritonitis in 61 (91 %) among 67 patients, with localized postoperative peritonitis – in 19 (13.4 %) of 142 patients. The first manifestations of intraabdominal complications after postoperative peritonitis were: the acute respiratory failure – in 95 (45.5 %) cases, cardiovascular failure – in 68 (32.5 %) cases, liver and renal dysfunction – in 46 (22 %) cases in the absence of clear local signs of the disease. 34 (42.5 %) out of 80 patients, who underwent the relaparotomy had 9–12 points of the Marshall score. One relaparotomy was performed in 46 (57.5 %) cases. Two relaparotomies were performed in 26 (32.5 %) cases, three relaparotomies – in 8 (10 %) cases. The need to repeat relaparotomy in 34 (42.5 %) cases was accompanied by a significant increase of mortality. So, after the first relaparotomy, 7 (15.2 %) out of 46 patients died, after the second relaparotomy – 12 (63.2 %) out of 19, after the third relaparotomy 6 (75 %). The use of precision technology, lavages of the abdominal cavity with solutions of antiseptics (8–12 liters) untill clean waters, intraabdominal applications of "Extranil", nasointetestinal intubation of the small intestine with other methods of treatment, helped to accelerate the elimination of signs of abdominal sepsis, decrease in the number of repeated relaparotomy, decrease postoperative lethality from 47.7 to 11.1 %.
References
Bondarev, R.V. & Bondarev, V.I. (2008). Sravnitelnye rezultaty lecheniya bolnykh ostrym razlitim peritonitom pri ispolsovanii metodov khirurgicheskoy detoksikatsii [Comparative results of treatment of patients with acute diffuse peritonitis using surgical detoxification methods]. Ukrainskyi zhurnal khirurhii – Ukrainian Journal of Surgery, 2, 73-77 [in Ukrainian].
Voronov, D.Ye., Kostyrnoi, O.V. & Polenok, P.V. (2012). Sanatsiia cherevnoi porozhnyny v likuvanni rozpovsiudzhenoho hniinoho perytonitu [Rehabilitation of the abdominal cavity in the treatment of diffuse purulent peritonitis]. Shpytalna khirurhiia – Hospital Surgery, 4, 114-116 [in Ukrainian].
Honchar, M.H. & Kuchirka, Ya.M. (2011). Suchasni metody likuvannia terminalnoi fazy zahalnoho perytonitu [Modern methods of treatment of the terminal phase of general peritonitis]. Ukrainskyi zhurnal khirurhii – Ukrainian Journal of Surgery, 6 (15), 90-92 [in Ukrainian].
Zhebrovskyy, V.V., Timoshin, A.D. & Gotye S.V. (2006). Oslozhneniya v khirurgii zhivota: Rukovodstvo dlya vrachey [Complications in abdominal surgery: Manual for Doctors]. Moscow: OOO “Meditsinskoye informatsionnoe agenstvo” [in Russian].
Kryvoruchko, I.A., Boyko, V.V., Ivanova, Yu.V. & Krasnoselskiy, N.V. et al. (2008). Povtornye operatsii pri vnutribryushnykh posleoperatsionnykh oslozhneniyakh [Repeated operations with intra-abdominal postoperative complications]. Klinichna Khirurhiia – Clinical Surgery, 11-12, 50-51 [in Ukrainian].
Popadiuk, O.Ya. (2017). Zastosuvannia biodehraduiuchykh polimernykh materialiv u abdominalnii khirurhii [Application of biodegradable polymeric materials in abdominal surgery]. Klinichna Khirurhiia – Clinical Surgery, 11.2 (908), 89 [in Ukrainian].
Savelyev V.S., Gelfand, B.R. & Philimonov, M.I. (2006). Peritonit: Prakticheskoye rukovodstvo [Peritonitis: Practical Guide]. Moskow: Literra [in Russian].
Shaprynskyi V.O. (1997). Zastosuvannia prohramovanoi relaparotomii v likuvanni –pisliaoperatsiinoho perytonitu [Application of programmable relaparotomy in the treatment of postoperative peritonitis]. Klinichna Khirurhiia – Clinical Surgery, 3-4, 74-76 [in Ukrainian].
Dhainaut, J.F., Yan, S.B., & Cleassens, Y.E. (2004). Protein C/activatedprotein C pathway: overview of clinical trial results in severe sepsis. Crit. Care Med., 32, 194-201.
Foitzik, T., & Hotz, В. (2002). Persistent multiple organ microcirculatory disorders in severe sepsis. Experimental findings and clinical implications. Dig. Dis. Sci., 47, 130-138.
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish their work in Hospital Surgery. Journal by L. Ya. Kovalchuk agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
