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Open management of the abdomen and planned reoperations in severe bacterial peritonitis
K Bosscha1, P F Hulstaert, M R Visser
1Department of Surgery, University Hospital Utrecht, The Netherlands.
Objective:
To assess the results of open management of the abdomen and planned re-operations in severe bacterial peritonitis after perforation or anastomotic disruption of the digestive tract.
Design:
Retrospective study.
Setting:
University Hospital, The Netherlands.
Subjects:
67 consecutive patients.
Interventions:
Open management of the abdomen and planned reoperations.
Main Outcome Measures:
Hospital morbidity and mortality, long-term follow-up.
Results:
38 patients developed multiple organ failure (MOF), but 29 needed only ventilatory and inotropic support. The mean number of re-operations was nine. 16 patients developed severe bleeding and 16 fistulas. In-hospital mortality was 42% (n = 28). Long-term morbidity, particularly the number of abdominal wall defects (n = 10), was considerable.
Conclusion:
Despite open management of the abdomen and planned re-operations, mortality of severe bacterial peritonitis still continues to be too high, and both short and long-term morbidity are appreciable. The value of open management of the abdomen and planned re-operations rests only on the clinical observation that other conventional surgical treatments of severe bacterial peritonitis often fail.