Prediction for a planned relaparotomy in secondary peritonitis

Šileikis, Audrius; Kazanavicius, Darius; Skrebūnas, Arminas; Ostapenko, A.; Strupas, Kęstutis

doi:10.2478/s11536-013-0180-7

Cited by 5 publications

(7 citation statements)

References 17 publications

(16 reference statements)

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“…In our study, most RL were done for emergency surgeries than elective (70.5% Vs 29.5%) which is in line with other studies (2,4,(6)(7)(14)(15)(16). Perforated appendicitis, bowel obstructions and trauma were the top surgeries complicated and required RL in this and many other studies (3,(6)(7)(8)(9)14,17). On the contrary, studies from developed nations demonstrated GI malignancies as the most common index surgery (1,15).…”

Section: Discussionsupporting

confidence: 90%

“…Literatures also reported that ODRL did have a substantial reduction in re-laparotomies, healthcare utilization including ICU, and medical costs ( 4 , 19 ). In addition, other authors suggested variables and scoring systems to decide on the choice of RL strategies following secondary peritonitis ( 5 , 9 ). In contrast with our study, reports of Indian and Turkey found that multiple RL was significantly associated with mortality ( 15 , 16 ).…”

Section: Discussionmentioning

confidence: 99%

“…Factors which influence outcomes of patients who underwent RL includes patient's sociodemographic characteristics, the indication for the first operation, the urgency of the first operation, the duration between first operation and RL, etc. ( 2 , 9 , 14 , 16 , 17 ). RL done for dehiscence and early obstruction carries minimal risk while RL for bleeding and infection entails moderate risks.…”

Section: Introductionmentioning

confidence: 99%

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Indications and Outcome of Patients who had Re-Laparotomy: Two Years’ Experience from a Teaching Hospital in a Developing Nation

Abebe

Geremew²,

Lemmu

et al. 2020

Ethiop J Health Sci

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BACKGROUND: Complications from abdominal surgery may necessitate a second or more surgeries, re-laparotomy. It is associated with significant morbidity and mortality. Data on relaparotomy from the developing nations is limited. This study aims to assess the indications and outcome of patients who had relaparotomyMETHODS: A retrospective review of medical records of all patients who underwent Re-laparotomy at St. Paul’s Hospital Millennium Medical College from January 2016 to December 2017 was done.RESULT: Of 2146 laparotomies, 6.9% (149) needed re-laparotomy and 129 patients were analyzed. Most (123,95.3%) had on-demand re-laparotomy. Patients operated on emergency made 70.5% (91) of the cases making the ratio of emergency to elective surgery 2.4:1. The three most common surgeries that needed re-laparotomy were, Perforated appendicitis (35,27.1%), bowel obstructions (28,21.7%) , and trauma (20,13.4%). The most common indications for relaparotomy were intra-abdominal abscess (57,44.23%), wound dehiscence (17,13.2%) and anastomotic leak (15 ,11.6%). Surgical site infection (128,100%) and malnutrition (58,45%) were the leading complications. The overall mortality rate was 12.8 % (19). There was no statically significant difference in mortality rate between on-demand and planned re-laparotomy (P=0.388), urgency of the primary surgery (P=0.891) and the number of relaparotomy (p=0.629). Re-laparotomy for anastomotic leak(p=0.001) and patients above fifty years of age (P=0.015) had significant associations with mortality.CONCLUSION: Intra-abdominal abscess collection, wound dehiscence and anastomotic leak were the most common indications of re-laparotomies. Age above fifty years and anastomotic leaks were significantly associated with mortality

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Indications and Outcome of Patients who had Re-Laparotomy: Two Years’ Experience from a Teaching Hospital in a Developing Nation

Abebe

Geremew²,

Lemmu

et al. 2020

Ethiop J Health Sci

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“…The overall mortality of patients with secondary peritonitis is reported to be between 12% and 79% [19,[28][29][30][31][32], while in our study, it is 9.9%. In our study, the incidence of relaparotomy for the postop collection was 23.3 %, which is in a higher range than most western literature (0.5 -15%) [11,12] . The mortality we observed after relaparotomy was 27.8%, comparable to most studies(24 to 71 %) [12,13,16] .…”

Section: Discussionmentioning

confidence: 44%

“…Secondary Peritonitis accounts for approximately 90% of all peritonitis cases in western countries [7,8] . Irrespective of the cause, successful management of peritonitis includes early administration of antibiotics, timely and effective surgical intervention, and supportive care to maintain organ function and limit the development of multiple organ failure [9][10][11] . One of the main causes of death is failure to control the initial infection and persistence of bacterial peritonitis.…”

Section: Research Articlementioning

confidence: 99%

Predictors of relaparotomy for persisting intra abdominal infection in secondary peritonitis

Tesfaye

Henock

Selase³

2021

CSRC

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Background: Peritonitis is one of the commonest causes of acute abdomen in Ethiopia. One of the causes of high morbidity and mortality is persistent intraabdominal infection. The two essential approaches for managing post-op collection are laparotomy on-demand and planned Relaparotomy. Despite multiple studies, both have comparative mortality. This study aimed to identify clinical variables that are predictive of persistent intraabdominal infection. Methods: A retrospective study was conducted on patients who were operated on from Sept 2018 to April 2020 at two affiliated referral hospitals of AAU, college of Medicine; Yekatit 12 hospital Medical College and Minilik II referral Hospital. All of the patients were cases of secondary peritonitis. Clinical progress of the patients from admission to discharge/death was documented. Multiple preoperative and intraoperative variables were analyzed to develop the predictive clinical model. Results: Out of 172 laparotomy cases for secondary peritonitis, 40 (23.3%) required relaparotomy for postop collection. From Patients who developed postop collection, 45% of them were diagnosed after pus/Gi content leaked through the surgical wound. The mortality rate of patients who develop postop collection and undergone relaparotomy was 27.5 % and 4.5% for those without postop collection. Logistic regression identified 4 variables as having significant predictive value: Duration of illness more than 5 days, Systolic BP 1000 ml, and small bowel as a source of contamination. Overall prediction successes of the above model is 88.4% (sensitivity 53.3%, specificity 96.8%). Conclusion: Management of persistent intra-abdominal infection is challenging. We have identified 4 clinical variables that predict persistent intraabdominal infection requiring relaparotomy. These sets of variables can be a milestone for future validation study before being inserted in today to day clinical practice.

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Epidemiological Characteristics, Antimicrobial Susceptibility Profile, and Surgical Outcome of Complicated Intra-Abdominal Infection at a Tertiary Hospital in Somalia

Yasin¹,

Ali²,

Ahmed³

et al. 2022

IJGM

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Background Intra-abdominal infections (IAIs) are common surgical emergencies and one of the leading causes of non-trauma deaths in hospitals worldwide. Because of limited resources, most patients in low-income countries experience delayed diagnosis and treatment. To the best of our knowledge, this is the first study to evaluate the epidemiological characteristics, antimicrobial susceptibility profile, and outcome of patients with complicated IAI at a tertiary hospital in Somalia. Methods This study included all patients with confirmed IAIs who underwent laparotomy or percutaneous drainage, either emergency or elective, and whose cultures showed growth. Sociodemographic and clinical characteristics, culture results, antimicrobial susceptibility profile, and the type of source control were reviewed. Results The prevalence of CIAI was 5.3%, 144 (70%) were male, and 61 (30%) were female. The mean age was 38.6±8.5 years. Appendicitis was the most common source of infection, accounting for 32%, followed by bowel perforation in 37 (18%). Out of 15 patients with liver abscesses, ten patients had diabetes (67%). E. coli 82 (40%) was the most common isolated organism, followed by Klebsiella pneumonia (n = 44, 21.5%). The prevalence of extended-spectrum beta-lactamase-producing and multidrug-resistant pathogens was 6.8% and 5.9%, respectively. The pathogens revealed a higher antimicrobial resistance against penicillins in 62%, cephalosporins in 54%, and fluoroquinolones in 44%. E. coli showed 2.5–13% antimicrobial resistance against carbapenems, lower than Klebsiella pneumonia in about 4.5%. Tigecycline, teicoplanin, and linezolid revealed the highest sensitivity against pathogens, about 100%. Source control was achieved by laparotomy in 81%, while the 19% were managed in a percutaneous approach. The mortality rate in our study was 9.3%. Conclusion The prevalence of CIAI in our study was 5.3%, with an increasing number of MDR microorganisms isolated from cultures. CIAI and intra-abdominal abscess are significant sources of high morbidity and mortality with sepsis and poor clinical outcome; thus, early detection and intervention are crucial.

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Prediction for a planned relaparotomy in secondary peritonitis

Cited by 5 publications

References 17 publications

Indications and Outcome of Patients who had Re-Laparotomy: Two Years’ Experience from a Teaching Hospital in a Developing Nation

Indications and Outcome of Patients who had Re-Laparotomy: Two Years’ Experience from a Teaching Hospital in a Developing Nation

Predictors of relaparotomy for persisting intra abdominal infection in secondary peritonitis

Epidemiological Characteristics, Antimicrobial Susceptibility Profile, and Surgical Outcome of Complicated Intra-Abdominal Infection at a Tertiary Hospital in Somalia

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