Scheduled sanations of abdominal cavity in complex treatment of acute diffuse purulent peritonitis

P.G. Kondratenko, E.A. Koychev

Abstract


Purpose of the research: to optimize the tactics in treatment of acute diffuse purulent peritonitis.
Patients and methods. 181 patients were under observation in the period from 1995 to 2013. All of them were operated on account of acute diffuse purulent peritonitis. The age of the patients varied from 28 to 86 years old. The men were 102 (56, 4%), the women — 79 (43, 6%). 90 (49, 7%) patients were younger than 60 years old. The concomitant disease was detected in 101 (55, 8) patients. The most common was cardiovascular and pulmonary dysfunction. The disease duration less than 3 days had 91 (50, 3%) patients, 4-6 days — 43 (23, 8%), and more than 6 days – 47 (25, 9%). The first degree of Mannheim Peritonitis Index (MPI) was detected in 27 (14, 9%) patients, second — in 112 (61, 9%), third — in 42 (23, 2%). Abdominal sepsis was observed in 154 (85, 1%) patients and multiple organ dysfunction – in 42 (23, 2%).
The results and consideration. Depending on a therapeutic approach the patients were divided in two groups. The first group consisted of 105 patients who had a standard method surgery and abdominal region was sutured tightly. If complications took place relaparotomy was performed (required relaparotomy).
The second group consisted of 76 patients who had a surgery finished with applying of laparostoma and following performance of scheduled sanations of abdominal cavity with the method described above. Besides, this group had carbapenems as starting empiric antibacterial therapy, method of “exposition sanation” and tactics for postsurgical management including abdominal closure terms which depend on intra-abdominal pressure.
The analysis of the results shows that the therapeutic approach for the patients of the 2nd group decreased the mortality rate from 50, 5% to 23, 7 %, and postsurgical complications from 21% to 6, 6%, comparing to the 1st group. At the same time suture failure in the 2nd group decreased from 7, 6% to 1, 3%, eventration from 2, 9% to 1, 3%. Also, such complications as abdominal abscesses and phlegmon of retroperitoneal tissue practically did not take place. Only postoperative wound infection was more frequent in the 2nd group than in the 1st group — 2, 6 % and 1, 9% correspondingly.
Conclusion. It is appropriate to finish the acute diffuse purulent peritonitis surgery with applying of laparostoma with following performance of scheduled sanations of abdominal cavity. The optimal interval between the scheduled abdominal sanations is 48 hours. It is advisable to perform the sanations with the solution “octenisept” with the method of “exposition sanation”. All the patients with acute diffuse purulent peritonitis must have intra-abdominal pressure monitoring. It is started at the final stage of the first surgery and finished after the restoration of intestinal peristalsis in postsurgical period after the abdominal cavity closure. Intra-abdominal pressure must not be above 10-15 mm Hg. It is necessary to perform intestinal decompression in all the patients with acute diffuse purulent peritonitis regardless of the stage of bowel loops dilatation during the first surgery. For this purpose can be used both the closed intestinal path of insertion of the probe (through nose) and open (through gastrostomy tube and jejunostomy tube).


Keywords


acute diffuse purulent peritonitis; laparotomy; scheduled sanations of abdominal cavity

References


Бондарев В.И. Выбор хирургической тактики при остром разлитом перитоните / Бондарев В.И., Бондарев Р.В // Хірургія України. — 2005. — №1(13). — С.96-99.

Борисов Д.Б. Оценка тяжести и интенсивная терапия распространенного перитонита / Д.Б. Борисов, Э.В. Недашковский // Вестник интенсивной терапии. — 2005. — N1. — С. 5-10.

Воронов Н.В. Лапаростомия при послеоперационном перитоните / Н.В. Воронов, Н.И. Стаценко, Рабах Закут Самир // Харківська хірургічна школа. — 2005. — N1. — С. 18-20.

Глабай В.П. Релапаротомии после неотложных операций на органах брюшной полости / В.П. Глабай, А.И. Шаров, А.А. Абрамов // Медицинский академический журнал. — 2003. — № 2., Т.3., Приложение 3. — С. 28-29.

Глухов А.А. Оценка тяжести состояния больных с острым распространенным перитонитом, осложненным абдоминальным сепсисом / А.А. Глухов, А.А. Андреев, О.П. Волобуева // Харківська хірургічна школа. — 2005. — N1. — С. 21-22.

Жебровский В.В. Оптимизация диагностики и лечения послеоперационного перитонита / В.В. Жебровский, И.В. Каминский, Мухаммед Муслих Аль-Ола // Харківська хірургічна школа. — 2005. — N1. — С. 32-36.

Кондратенко П.Г. Роль и место программных санаций брюшной полости в хирургическом лечении разлитого гнойного перитонита / П.Г. Кондратенко, Е.А. Койчев // Украинский журнал хирургия. — 2011. — № 3. — С. 86-91.

Кондратенко П.Г. Рациональная стартовая антибактериальная терапия в комплексном лечении больных с распространенным гнойным перитонітом / П.Г. Кондратенко, Л.В. Натрус, Е.А. Койчев // Украинский журнал хирургия. — 2014.- №1. — С. 50-55.

Савельев В.С. Перитонит: Практическое руководство / В.С. Савельева, Б.Г. Гельфанда, М.И. Филимонова [и др.]. — М.: Литера, 2006. — 208 с.

Сипливый В. А. Этиологическая структура и чувствительность к антибиотикам возбудителей инфекционных процессов в общехирургическом стационаре. / В. А. Сипливый, А. Я. Цыганенко, Е. В. Конь [и др.] // Клиническая хирургия. — 2009. — №10. — С. 29-32.

Intraabdominal hypertension and the abdominal compartment syndrome / A. F . Mo o r e, R. Hargest, M. Martin et al. // Br. J. Surg. — 2004. — Vol. 91 (9). — P. 1102-1110.

Muntean V. Acute intraabdominal hypertension and «abdominal compartment syndrome» / V. Muntean, R. Galasiu, O. Fabian // Chirurgia (Bucur). — 2002. — Sep — Vol. 97 (5). — P. 447- 457.

Pottecher T. Abdominal compartment syndrome / T. Pottecher, P. Segura, A. Launoy / Serviced’anesthesie reanimation chirurgicale, hopital de Hautepierre, 67098 Strasbourg, France // Ann Chir. — 2001. — Vol. 126 (3). — P. 192 — 200.




DOI: https://doi.org/10.22141/1997-2938.3-4.26-27.2014.83204

Refbacks

  • There are currently no refbacks.


Copyright (c) 2016 UKRAINIAN JOURNAL OF SURGERY

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2017

 

 Яндекс.МетрикаSeo анализ сайта Рейтинг@Mail.ru