Complications of planned relaparotomy in patients with severe general peritonitis

To analyse the complications of planned relaparotomy for severe general peritonitis and to define when to discontinue relaparotomies.

Retrospective study.

University hospital, The Netherlands.

24 consecutive patients who underwent planned relaparotomy for widespread faecal peritonitis caused by large bowel perforation (n = 15) or postoperative anastomotic leakage (n = 9).

136 planned relaparotomies and 23 emergency laparotomies for intra-abdominal bleeding.

Mortality, intra-abdominal complications, multiple organ failure (MOF) scores, and cultures of the abdominal cavity.

Seven patients died (29%). These patients had significantly higher MOF scores than survivors (p < 0.001) MOF scores did not change during the first seven days. Intra-abdominal complications were more common among those that died than survivors (p < 0.02) and correlated strongly with the number of planned relaparotomies (r = 0.90; p < 0.001). In all but three patients intra-abdominal cultures ceased to grow pathogens (< 10(3) cfu/ml microorganisms) after a median of 3 relaparotomies. Patients in whom fascial closure was achieved had undergone significantly fewer relaparotomies than those in whom it was not possible (P < 0.05).

Planned relaparotomy seems to be associated with appreciable morbidity and does not reverse organ dysfunction. The criterion of < 10(3) cfu/ml before cessation of planned relaparotomies might be useful.