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Scheduled relaparotomies using a zipper system for the treatment of diffuse generalized peritonitis in children
G Roeyen1, G Hubens, W Vaneerdeweg
1Department of Surgery, University Hospital, Antwerp, Belgium.
Insights
Planned relaparotomies with a zipper system safely treat pediatric peritonitis. This approach, involving peritoneal lavages, proved effective in controlling intra-abdominal sepsis in young patients, leading to survival in all cases.
Area of Science:
- Pediatric Surgery
- Critical Care Medicine
- Infectious Diseases
Background:
- Diffuse peritonitis requires aggressive management, often involving planned relaparotomies and peritoneal lavages.
- The use of zipper systems for peritoneal lavage is established in adults but less documented in pediatric populations.
Purpose of the Study:
- To review the safety and efficacy of zipper-assisted peritoneal lavage in pediatric patients with severe intra-abdominal sepsis.
- To evaluate the outcomes of planned relaparotomies using a zipper system in children.
Main Methods:
- A retrospective review of 7 pediatric patients (5 days to 13 years) treated with a zipper system for intra-abdominal sepsis over 3 years.
- Patients underwent planned relaparotomies with peritoneal lavages every 24-48 hours.
- Etiologies included necrotizing enterocolitis, postoperative complications, and perforated appendicitis.
Main Results:
- All 7 pediatric patients survived the treatment.
- Peritoneal lavage with a zipper system was used to manage intra-abdominal sepsis.
- An average of 1.9 lavages were required before zipper removal and primary abdominal closure.
- Patient physical status (APS) ranged from 12 to 22 (mean 17.7).
Conclusions:
- Planned relaparotomies with peritoneal lavages using a zipper system can be safely performed in pediatric patients, including neonates.
- This technique appears effective for controlling severe intra-abdominal sepsis in children.
- Further research is needed to establish definitive efficacy and compare outcomes with alternative treatments.
Abstract:
In the treatment of diffuse peritonitis, planned relaparotomies with peritoneal lavages using a zipper system (EthiZip Ethicon) are sometimes necessary to obtain a complete eradication of the infectious focus. While most reported series are dealing with an adult population, this review focuses on the treatment of peritonitis using a zipper system in a paediatric age group. In a period of 3 years, insertion of a zipper device and peritoneal lavages were considered necessary to control intraabdominal sepsis in 7 children (age varying from 5 days to 13 years). They consequently underwent planned relaparotomies with peritoneal lavages every 24 to 48 hours. The peritonitis was caused by necrotizing enterocolitis (3 patients), postoperative complications (3 patients) and long existing perforated appendicitis (1 patient). Physical status, assessed by the Acute Physiologic Score (A.P.S.), varied from 12 to 22 (mean 17.7). Usually more than one lavage was necessary (1 to 3, mean 1.9) before the abdomen was considered clean and the zipper could be removed. Closure of the abdominal cavity could be achieved primarily in all cases. All patients survived. Although no statistically significant conclusions can be drawn from this small series and although it is unclear whether these children would not have survived without the zipper, this review shows that planned relaparotomies with peritoneal lavages using a zipper system can be performed safely even in very small children.