Intra-abdominal sepsis: the role of surgery

Gallinaro, Robert N.; Polk, Hiram C.

doi:10.1016/0950-3528(91)90045-3

Cited by 7 publications

(2 citation statements)

References 61 publications

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“…Included among these are necrotic tissues, fibrin, blood, feces, gastrin mucin, and bile [4], and they may contribute to loculation of bacteria and abscess formation. Included among these are necrotic tissues, fibrin, blood, feces, gastrin mucin, and bile [4], and they may contribute to loculation of bacteria and abscess formation.…”

Section: Discussionmentioning

confidence: 99%

Peritoneal host defenses are less impaired by laparoscopy than by open operation

et al. 1995

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There is a growing body of evidence that laparoscopic surgery is physiologically less injurious than open surgery. We hypothesized that the open technique results in a greater impairment of peritoneal and systemic defense mechanisms than does the laparoscopic technique. Nissen fundoplication, standardized in technique and duration, was performed in 16 pigs. The procedure was performed through a standard midline incision (OPEN, n = 8) or with laparoscopic technique and CO2 pneumoperitoneum (LAP, n = 8). The peritoneal cavity was instilled with 400 cc of normal saline, either alone (not contamined, n = 8) or containing 10(9) E. coli/ml (contaminated, n = 8). Quantitative cultures, cell count, and flow cytometry were performed on blood and peritoneal fluid samples obtained at timed intervals. We found that host defense processes were better preserved after LAP than by OPEN surgery. Peritoneal and systemic monocyte class II antigen expression, and serum tumor necrosis factor-alpha activity was greater in the OPEN group compared with the LAP group, but peritoneal bacterial clearance was more efficient in the LAP group. These data may illustrate a potential benefit of laparoscopic surgery in cases of peritoneal contamination.

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Section: Discussionmentioning

confidence: 99%

Peritoneal host defenses are less impaired by laparoscopy than by open operation

et al. 1995

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“…The finding that the peritonitis factor ‘ischaemia’ influenced the preference score for surgical treatment strategy towards PR can be explained by the surgeons’ possible argument that after an initial laparotomy for ischaemia, a PR is warranted to reassess viability or to re-establish bowel continuity in case of stapled-off loops [17]. However, in clinical practice a distinction should probably be made between mesenteric ischaemia as a result of arterial insufficiency and ‘local’ ischaemia as a result of mechanical obstruction.…”

Section: Discussionmentioning

confidence: 99%

Survey among Surgeons on Surgical Treatment Strategies for Secondary Peritonitis

Lamme

Boermeester²,

Vos³

et al. 2004

Dig Surg

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Background: There is controversy about performing either a planned relaparotomy (PR) or relaparotomy on demand (ROD) in patients with secondary peritonitis. Subjective factors influencing surgeons in decision making for either surgical treatment strategy have never been studied. Methods: All 858 surgeons of the Association of Surgeons of The Netherlands were sent a survey with 16 case vignettes simulating peritonitis patients and evaluating the preference for PR or ROD. Results: Sixty-two percent of surgeons responded to the survey. Of the returned surveys, 407 were eligible for evaluation. The responding surgeons had a slight overall preference for the ROD strategy, as shown by the mean overall preference score of 5.2 (range 3.54–6.52, with a maximal score of 7). Gastrointestinal surgeons and surgeons working in regional and smaller hospitals were significantly more in favour of a ROD strategy than their counterparts. Factors significantly influencing the preference towards PR were ischaemia as aetiology and performing a primary anastomosis; as for ROD, it was small bowel as focus, local extent of contamination and the question whether abdominal closure was possible. However, there was a considerable variability in treatment decisions by surgeons. Conclusion: The majority of responding surgeons would make a choice for a particular treatment strategy based on peritonitis and surgical treatment characteristics. There was a slight overall preference towards the ROD strategy despite the considerable variability per case vignette.

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Pancreatic and hepatic abscesses: A late complication in 10 patients with chronic pancreatitis

et al. 1992

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Intra-abdominal sepsis: the role of surgery

Cited by 7 publications

References 61 publications

Peritoneal host defenses are less impaired by laparoscopy than by open operation

Peritoneal host defenses are less impaired by laparoscopy than by open operation

Survey among Surgeons on Surgical Treatment Strategies for Secondary Peritonitis

Pancreatic and hepatic abscesses: A late complication in 10 patients with chronic pancreatitis

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