[Laparotomy closure in advanced peritonitis].

Area of Science:

• Surgical critical care
• Abdominal surgery
• Peritonitis management

Background:

• Advanced peritonitis presents significant management challenges and high mortality rates.
• Current strategies for peritonitis require optimization to improve patient outcomes.
• Abdominal wall closure techniques impact postoperative complications and survival.

Purpose of the Study:

• To evaluate the efficacy of programmed relaparotomy with removable draining musculoaponeurotic seams in advanced peritonitis.
• To compare outcomes between different abdominal wall closure strategies in peritonitis patients.
• To identify prognostic factors for mortality in advanced peritonitis.

Main Methods:

• A study involving 743 patients with advanced peritonitis.
• Patients were stratified into two groups based on treatment strategies.
• Analysis of mortality and postoperative suppuration incidence based on surgical techniques.

Main Results:

• Programmed relaparotomy with draining seams reduced mortality from 47.8% to 24.1% (p<0.001) and suppuration incidence 4-fold (p<0.001).
• Exclusive use of cutaneous seams in persistent abdominal hypertension further decreased mortality to 15.8% (p<0.05).
• APACHE-III scores demonstrated significant prognostic value.

Conclusions:

• Programmed relaparotomy with removable draining musculoaponeurotic seams is recommended for advanced peritonitis.
• Cutaneous seams are indicated for persistent abdominal hypertension to reduce mortality.
• Abdominal wall repair is crucial for large eventrations; APACHE-III aids prognostication.