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Multiple laparotomies for severe intra-abdominal infection
B A Jiffry1, M W Sebastian, T Amin
1Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
The Australian and New Zealand Journal of Surgery
|March 11, 1998
Summary
Planned re-laparotomy and peritoneal lavage significantly decreased mortality in severe peritonitis patients. This surgical approach improved outcomes compared to predicted mortality rates, especially in high-risk cases.
Area of Science:
- Surgical critical care
- Infectious disease management
- Abdominal surgery outcomes
Background:
- Severe peritonitis carries high mortality rates.
- Effective management strategies for severe peritoneal infection are crucial.
- Planned re-laparotomy is a potential intervention for severe peritonitis.
Purpose of the Study:
- To evaluate the impact of planned re-laparotomy on mortality in severe peritonitis.
- To compare actual mortality rates with APACHE II predicted mortality.
- To assess the efficacy of single versus multiple peritoneal lavage procedures.
Main Methods:
- Retrospective analysis of 52 patients with severe peritoneal infection.
- Data collected from King Faisal Specialist Hospital and Research Centre (1992-1994).
- Patients underwent single (n=30) or multiple (n=22) peritoneal lavage.
Main Results:
- Actual mortality was lower than APACHE II predicted mortality for both single (23% vs 42.4%) and multiple (36.3% vs 55.6%) lavage groups.
- No deaths occurred in patients with predicted mortality <30% undergoing multiple washouts.
- Mortality increased with higher predicted mortality scores, but actual rates remained lower than predicted.
Conclusions:
- Planned re-laparotomy and peritoneal lavage can significantly reduce mortality in severe peritonitis.
- The APACHE II scoring system can predict mortality, but planned re-laparotomy appears to improve outcomes.
- This approach offers a viable strategy for managing severe peritoneal infections.