Reconstructive abdominal operations after laparostomy and multiple repeat laparotomies for severe intra-abdominal infection

Abstract

Between 1980 and 1993, 18 patients underwent formal laparotomy after laparostomy and healing of the peritoneal cavity by granulation. The majority (12 patients) were men and the median age was 47 (range 22-67) years. Intraabdominal infection following surgery for Crohn's disease (four patients) and necrotizing pancreatitis (six) was the most common primary condition requiring laparostomy. A total of 23 reconstructive operations were carried out on the 18 patients a median of 6 (range 1-18) months after laparostomy. The indication for surgery was for closure and/or resection of an enteric fistula in 13 patients. The site of the fistula included three gastric, two duodenal, 11 small bowel and seven colonic. A further four patients required operation for closure or refashioning of a stoma. Five patients subsequently required a second laparotomy: two for elective restoration of bowel continuity, two for recurrent fistula and one for an acute abdomen. After reconstructive surgery following laparostomy 16 patients were discharged home alive and well, one requiring home parenteral nutrition for short bowel syndrome. In contrast, the two oldest patients in the series died from multiple organ failure immediately after initial reconstructive surgery. Both had pre-existing medical problems and in neither was there evidence of further intra-abdominal infection after reconstruction.

Outcome of 132 Consecutive Reconstructive Operations for Intestinal Fistula—Staged Operation Without Primary Anastomosis Improved Outcome in Retrospective Analysis

“…MORTALITY AND HEALING: 1988-1999VERSUS 2000-2003 The later period showed better outcome because mortality was lower and healing rate increased at the Linköping University Hospital. From the year 2000 and on, the operations and perioperative care were concentrated to one group of surgeons employing established principles for the treatment, including enteral sond nutrition largely replacing TPN, a time period of 6 months after previous laparotomy before fistula closure, and preferentially staged operations with stoma avoiding anastomosis (24)(25)(26). In this period, primary anastomosis was used in only 13 (43%) of 30 operations compared to 53 of 73 (73%) previously (p = 0.0023).…”

Small bowel enterocutaneous fistulae: the merits of early surgery

“…In the second half of the last century the mortality in reputed centres decreased to 5%-25% [4][5][6][7] because of improved surgical, metabolic, and medical care. At present, the treatment of patients with an abdominal wall defect in which a fi stula develops in the exposed intestine is probably the biggest challenge [8]. The few retrospective studies available in the literature concerning these patients are either incomplete or only describe small numbers [9][10][11][12][13][14].…”

Reconstrução abdominal tardia sem tensão após laparostomia: uma nova técnica

“…A etapa IV é realizada com intervalo de seis a doze meses após a alta hospitalar, envolvendo a técnica de separação dos componentes para a reconstrução da parede abdominal 22 . A grande dificuldade encontrada pelo cirurgião na execução desta técnica está na liberação das aderências viscerais do tecido cicatricial da laparostomia, o que torna elevado o risco de formação de fístulas enterocutâneas 13,14,16,20,21 . As taxas de herniação com este procedimento variam de 22% a 32% 21, 23. Méto-dos alternativos para a reconstrução por etapas foram descritos por outros autores 10,16 .…”

“…Diversas técnicas foram descritas para a reconstrução abdominal tardia 5,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] , sendo que a maior parte delas envolve a utilização de enxertos de pele, transformando o defeito abdominal em uma hérnia incisional, seguido da complexa técnica de separação de componentes. Estas técnicas demandam procedimentos múltiplos e requerem a liberação das extensas aderências entre o tecido de granulação já epitelizado e as vísceras abdominais.…”