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[Mode of surgery completion in peritonitis]
Abstract:
1310 patients with various forms of peritonitis were operated during 1989-1998. The tactics of the treatment was determined depending on bacterial contamination of the abdominal cavity. In abscesses of the abdominal cavity with massive bacterial contamination (6-7 CFU/g) drainage procedure was used. Mortality rate made up 4.8%. In local extended and diffuse peritonitis with a slight bacterial contamination of the abdominal cavity (3-5 CFU/g) and in absence of fibrinous deposition fixed on peritoneum, the drainage of the abdominal cavity was not used, and laparoscopy was performed in postoperative period for the control of the course of infectious process. Mortality rate was 0.6%. In extended peritonitis with massive bacterial contamination (6-8 CFU/g) the method of repeated explorations and sanitations of the abdominal cavity was used, mortality rate being 17.8%. The overall lethality made up 7.8%. Postoperative wound infection occurred in 6.7%, intraabdominal infection as abscesses or progressing peritonitis--in 2.1% of cases.
Insights
Treatment tactics for peritonitis depend on bacterial contamination. Drainage reduced mortality in severe cases, while laparoscopy improved outcomes in less contaminated peritonitis, highlighting tailored approaches for better patient survival.
Area of Science:
- Surgical Gastroenterology
- Infectious Diseases
- Clinical Medicine
Background:
- Peritonitis, an inflammation of the abdominal lining, presents diverse clinical scenarios.
- Treatment strategies historically varied, impacting patient outcomes.
- Bacterial contamination levels are a critical factor in peritonitis management.
Purpose of the Study:
- To evaluate the impact of different surgical treatment tactics for peritonitis.
- To correlate treatment strategies with bacterial contamination levels and patient outcomes.
- To determine the efficacy of drainage versus non-drainage approaches in peritonitis management.
Main Methods:
- Retrospective analysis of 1310 patients operated for peritonitis between 1989-1998.
- Classification of peritonitis based on bacterial contamination (CFU/g) and extent (local, diffuse).
- Comparison of outcomes (mortality, infection rates) based on treatment: drainage, no drainage with laparoscopy, or repeated explorations/sanitation.
Main Results:
- Drainage for massive contamination (6-7 CFU/g) in abscesses had a 4.8% mortality rate.
- Non-drainage with postoperative laparoscopy for slight contamination (3-5 CFU/g) showed a significantly lower mortality rate of 0.6%.
- Repeated explorations for extended peritonitis with massive contamination (6-8 CFU/g) resulted in a high mortality rate of 17.8%.
Conclusions:
- Tailored surgical tactics based on bacterial load and peritonitis type are crucial for reducing mortality.
- Minimally invasive approaches like laparoscopy can be effective in selected peritonitis cases.
- Aggressive management with repeated interventions in severe contamination carries a substantial risk, necessitating careful consideration.