Prophylactic mesh placement in emergency midline laparotomy for intestinal perforation peritonitis: An appeal for caution

Kumar, Vivek Vijay; Verma, Amrendra; Thakur, Dileep Singh; Somashekar, Uday; Kothari, Reena; Sharma, Dhananjaya

doi:10.1177/00494755221110831

Cited by 2 publications

(2 citation statements)

References 24 publications

(54 reference statements)

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“…Primary peritoneal drainage (PPD) is an alternative to emergency laparotomy. Emergency rooms across the country see a lot of patients with intestinal perforations 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Percutaneous Peritoneal Drainage Among Patients with High Risk Perforated Peritonitis in Tertiary Care Hospitals

Noshad¹,

Ahmad²,

Iqbal³

et al. 2023

PJMHS

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Aim: The aim of this study was to evaluate the effectiveness of percutaneous peritoneal drainage (PPD) as a treatment option for high-risk perforated peritonitis in tertiary care hospitals. Methods: This prospective investigation was conducted at multiple centres including Department of Surgery, Quaid-e-Azam Medical College / Bahawal Victoria Hospital Bahawalpur and Jinnah International Hospital, Abbottabad from August, 2022 to January, 2023. Patients with peritonitis accompanied by shock or who did not respond to initial resuscitative protocols were included in the study. Patients with primary peritonitis or spontaneous bacterial peritonitis and those with a history of multiple previous abdominal surgeries were excluded. The study evaluated the effectiveness of PPD as a treatment option for high-risk perforated peritonitis. Chi Square test was applied to assess association keeping P value < 0.05. Results: The mean age was 54.81±9.2 years, male patients were 66 (57.9%) while female patients were 48 (42.1%). Regarding mortality after PPD 25 (21.9%) patients died, while 15 (13.2%) patients died after definitive surgery. Mortality after PPD was significantly associated with systolic BP < 90 mmHg and comorbid. Conclusion: Based on our study findings, we have determined that percutaneous peritoneal drainage is a crucial procedure that can potentially save lives and lead to improved outcomes in high-risk patients undergoing laparotomy. Moreover, it has the potential to enhance their preoperative condition. Keywords: High risk patients, Primary peritoneal drainage, Perforation peritonitis

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“…Primary peritoneal drainage (PPD) is an alternative to emergency laparotomy. Emergency rooms across the country see a lot of patients with intestinal perforations 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Percutaneous Peritoneal Drainage Among Patients with High Risk Perforated Peritonitis in Tertiary Care Hospitals

Noshad¹,

Ahmad²,

Iqbal³

et al. 2023

PJMHS

View full text Add to dashboard Cite

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“…The disease is a complication of a number of surgical diseases or abdominal injuries (acute appendicitis, perforated gastric and duodenal ulcer, acute gangrenous cholecystitis, pancreatic necrosis, perforation of hollow organs, their damage during trauma, etc.) in the vast majority of cases [22,27,28]. Mortality in DPP is about 20-30%, reaching the highest figures in the development of multiple organ failure and septic shock, the prevention and relief of which are key in the treatment of peritonitis [33,34].…”

Section: Introductionmentioning

confidence: 99%

Disseminated purulent peritonitis outcome affects NKT cell phenotype

Савченко

Борисов

Kudryavtsev

et al. 2022

Russian Journal of Infection and Immunity

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The aim of our study was to investigate the main characteristics of peripheral blood NKT cell phenotype in patients with disseminated purulent peritonitis (DPP) in dynamics of postoperative period, depending on the disease outcome. Fifty-two patients with acute surgical diseases and injuries of the abdominal organs complicated by DPP, and 68 healthy individuals in control group, were examined. Blood sampling was performed before surgery (preoperative period), as well as on the day 7, 14 and 21 of postoperative period. All patients with DPP were divided into two groups depending on disease outcome in postoperative period: patients with favorable disease outcome (n = 34); and patients with unfavorable outcome (n = 18). Study of the phenotype of blood NKT lymphocytes was performed by flow cytometry using direct immunofluorescence of whole peripheral blood samples with monoclonal antibodies. The low relative and absolute level of NKT cells was observed in DPP patients regardless of outcome disease in preoperative period. At the same time, the absolute level of NKT cells returned to normal only in patients with favorable DPP outcome and only by day 21 after surgery. Patients with favorable DPP outcome by the end of examination period had normalized quantity of mature NKT-lymphocytes and significantly decreased level of cytotoxic cells which was apparently associated with migration of such cell subsets to site of inflammation. A reduced level of non-classical (expressing CD8 marker) mature and cytokine-producing NKT cells was detected only in patients with favorable DPP outcome in preoperative period which returned to normal by the end of postoperative period. At the same time, patients with unfavorable disease outcome had reduced quantity of NKT cells of these subsets by day 21 of postoperative treatment. Patients with favorable outcome had high level of mature and cytotoxic CD11b+ NKT cells already in the preoperative period, while patients with unfavorable DPP outcome had increased level of cytotoxic CD11b+ NKT cells only by day 21 after surgery. The proportion of NKT cells expressing activation markers (CD28 and CD57) was reduced in patients in preoperative period that returned to normal immediately after surgery with favorable outcome, while it recovered with unfavorable outcome closer to the end of postoperative examination. The defined features of NKT cell phenotype in patients with unfavorable DPP outcome characterize disturbances in subset ratio and mechanisms of functioning of this cell fraction. This determines a need to develop immunotherapeutic methods aimed at stimulating immunoregulatory activity of NKT cells.

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Prophylactic mesh placement in emergency midline laparotomy for intestinal perforation peritonitis: An appeal for caution

Cited by 2 publications

References 24 publications

Evaluation of Percutaneous Peritoneal Drainage Among Patients with High Risk Perforated Peritonitis in Tertiary Care Hospitals

Evaluation of Percutaneous Peritoneal Drainage Among Patients with High Risk Perforated Peritonitis in Tertiary Care Hospitals

Disseminated purulent peritonitis outcome affects NKT cell phenotype

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