Planned reoperation for generalized intraabdominal infection

Andrus, Charles H.; Doering, Matthew; Herrmann, Virginia M.; Kaminski, Donald L.

doi:10.1016/0002-9610(86)90448-4

Cited by 33 publications

(11 citation statements)

References 7 publications

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“…However, the presence of these factors indicates progression to MOD, and the goal is to identify the patients before the development of MOD. Lamme et al [9] performed a meta-analysis of re-laparotomy for secondary peritonitis in 2002, including eight observational studies [5,[10][11][12][13][14][15][16]. A total of 1,266 patients from the eight studies were included in the meta-analysis (286 planned laparotomy and 980 laparotomy on demand) [9].…”

Section: Mandell and Arbabimentioning

confidence: 99%

Re-Laparotomy for Severe Intra-Abdominal Infections

Mandell

Arbabi

2010

Surgical Infections

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Section: Mandell and Arbabimentioning

confidence: 99%

Re-Laparotomy for Severe Intra-Abdominal Infections

Mandell

Arbabi

2010

Surgical Infections

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“…[1][2][3][4][5][6] The standard method of "on demand" relaparotomy, closed postoperative lavage methods, and different lavage variants of open and semiopen treatment of the abdominal cavity are currently in competition. Nevertheless, more than 80% of all peritonitis cases can be successfully treated with the standard method.…”

mentioning

confidence: 99%

Circulating Mediators and Organ Function in Patients Undergoing Planned Relaparotomy vs Conventional Surgical Therapy in Severe Secondary Peritonitis

Zügel

Siebeck²,

Geissler³

et al. 2002

Archives of Surgery

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Hypothesis: Planned relaparotomy (PRL) has been suggested to have detrimental effects on the systemic activation of inflammation mediators, thereby enhancing organ dysfunctions as assessed by clinical scores in secondary peritonitis.Design: Prospective, nonrandomized control trial.Setting: Intensive care units of an urban and a university teaching hospital.Patients: Twenty-nine patients with secondary peritonitis.Interventions: Of the 29 patients with comparable initial peritonitis conditions, 11 underwent PRL and 18 obtained primary abdominal closure. Blood samples were obtained preoperatively and at 2, 6, 8, 12, 18, 24, 30, 36, 42, and 48 hours after the primary operation, then every 12th hour until day 5 and once daily until day 8. Main Outcome Measures: Quantification of circulating inflammation parameters (coagulation, acute-phase proteins, cytokine system, cell adhesion, opsonization) in correlation with Acute Physiology and Chronic Health Evaluation II, multiple organ failure, and Sepsis-Related Organ Failure Assessment scores.Results: Preoperatively, the patient groups did not differ in mean age, cause of peritonitis, or clinical scores. On average, 5.1 (SEM, ± 0.7; range, 3-11) lavage treatments were performed in the PRL group, with 90% of the procedures executed during the first 6 days. The PRL treatment resulted in a significantly higher need of blood components and an increased inflammation mediator response, especially concerning coagulation factors, proinflammatory cytokines, adhesion molecules, and opsonic parameters. During PRL, clinical score systems showed higher values and a delayed decline compared with primary abdominal closure treatment. Incidence of multiorgan failure, mortality, and the mean intensive care unit hospitalization period were clearly more pronounced in the PRL group. Conclusion:In our pilot study, additional lavage treatment of secondary peritonitis resulted in an enhancement of systemic inflammatory mediator response (in particular interleukin 8), which may contribute to a further impairment of organ function.

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“…Three studies have found no significant difference in mortality rate [40,49,50]. Mortality rates from planned relaparotomy vary from 21% to 38%, compared to 13% to 42% for relaparotomy on demand.…”

Section: Planned Relaparotomymentioning

confidence: 97%