Sequential abdominal reexploration with the zipper technique
M A Cuesta1, M Doblas, L Castañeda
1Department of Surgery, Hospital Virgen de la Salud, Toledo, Spain.
Abstract:
Frequently, several multiple abdominal reexplorations are needed in patients with acute necrotizing hemorrhagic pancreatitis (ANP) or with persistent intraabdominal sepsis (PIAS). Residual undrained necrotic and septic foci lead to multiple organ failure. To provide wide-open drainage of the abdominal cavity, since 1985 we have performed sequential abdominal reexploration with the zipper technique (SARZT) in 24 patients. Apache II score was used to evaluate expected mortality. In the pancreatic necrosis group, with a mean Apache II score of 31, the expected and the observed mortality were 70% and 29%, respectively. In the PIAS group, with a mean Apache II score of 30, the expected and observed mortality were 60 and 28%, respectively. These results are attributed to the sequential reexploration of the abdominal cavity that permits excision and drainage of necrotic and septic foci.
Insights
Sequential abdominal reexploration with the zipper technique (SARZT) significantly reduces mortality in patients with severe pancreatitis or abdominal sepsis. This approach allows for effective drainage of infected areas, improving patient outcomes.
Area of Science:
- Surgical Gastroenterology
- Critical Care Medicine
Background:
- Acute necrotizing hemorrhagic pancreatitis (ANP) and persistent intraabdominal sepsis (PIAS) often necessitate multiple abdominal reexplorations.
- Undrained necrotic or septic foci can lead to severe complications, including multiple organ failure.
Purpose of the Study:
- To evaluate the efficacy of sequential abdominal reexploration with the zipper technique (SARZT) in managing ANP and PIAS.
- To assess the impact of SARZT on patient mortality compared to expected mortality rates.
Main Methods:
- The study involved 24 patients treated with SARZT since 1985.
- The Apache II score was utilized to determine expected mortality rates.
- Patients were categorized into pancreatic necrosis and PIAS groups.
Main Results:
- In the pancreatic necrosis group (mean Apache II score 31), observed mortality was 29% versus an expected 70%.
- In the PIAS group (mean Apache II score 30), observed mortality was 28% versus an expected 60%.
- SARZT facilitated wide-open drainage and excision of necrotic and septic foci.
Conclusions:
- Sequential abdominal reexploration with the zipper technique is an effective strategy for reducing mortality in complex abdominal sepsis and pancreatitis.
- The technique's success is attributed to its ability to provide comprehensive drainage and debridement of infected abdominal cavities.
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