Department of Visceral, Minimally Invasive and Oncologic Surgery, Marien Hospital Düsseldorf, Rochusstr. 2, 40479, Düsseldorf, Germany.
Department of General, Visceral and Transplantation Surgery, University of Muenster, Albert-Schweitzer Campus 1, Waldeyerstr. 1, Münster, Germany.
World J Surg. 2020 Jul;44(7):2185-2190. doi: 10.1007/s00268-020-05455-9.
Secondary peritonitis is associated with high rates of morbidity and mortality. Data on the effect of staged re-laparotomy or re-laparoscopy as a surgical option in the management of abdominal sepsis due to secondary peritonitis are limited and conflicting. Herein, we report the outcomes of patients undergoing staged peritoneal lavage (SPL) for secondary peritonitis in our department.
This is a single-center retrospective analysis of the data of patients undergoing SPL for secondary peritonitis. SPL was performed via either re-laparotomy or re-laparoscopy. The simplified acute physiology score (SAPS II) was calculated at the time of the initial operation and for each SPL. The end points of interest included: the evolution of sepsis characterized by the SAPS II score, the mortality rate and the rate of definitive abdominal wall closure.
The data of 74 patients with a median age of 73 years requiring at least one SPL between 2012 and 2019 were analyzed. The median number of SPL performed was three (range 1-12). A sequential drop of SAPS II score from 41 at the initial procedure to 32 at the third SPL was documented. The overall mortality rate was 16.2%, definitive abdominal closure was achieved in all surviving patients and the median length of stay was 17.5d CONCLUSION: Staged re-laparotomy or re-laparoscopy with peritoneal lavage may reduce the severity of peritonitis and reduce the risk of mortality in patients with abdominal sepsis. Maintaining the abdominal wall under constant retraction using a rigid mesh while creating an open abdomen is a crucial step in achieving definite abdominal wall closure. Thus, staged peritoneal lavage may be a good surgical option for selected patients with peritonitis.
继发性腹膜炎与高发病率和死亡率相关。关于分期剖腹术或剖腹再腹腔镜检查作为治疗继发性腹膜炎引起的腹部脓毒症的手术选择的效果的数据有限且存在冲突。在此，我们报告了我们科室接受分期腹膜灌洗（SPL）治疗继发性腹膜炎的患者的结局。
这是一项对因继发性腹膜炎接受 SPL 的患者进行的单中心回顾性分析。SPL 通过剖腹术或剖腹再腹腔镜检查进行。在初次手术和每次 SPL 时计算简化急性生理学评分（SAPS II）。感兴趣的终点包括：以 SAPS II 评分特征的脓毒症演变、死亡率和确定性腹壁闭合率。
分析了 2012 年至 2019 年期间至少需要进行一次 SPL 的 74 例中位年龄为 73 岁的患者的数据。中位数 SPL 次数为 3 次（范围 1-12 次）。从初次手术的 41 分记录到第 3 次 SPL 的 32 分，SAPS II 评分呈连续下降。总的死亡率为 16.2%，所有存活患者均实现了确定性腹壁闭合，中位住院时间为 17.5d。
分期剖腹术或剖腹再腹腔镜检查联合腹膜灌洗可能降低腹膜炎的严重程度，并降低腹部脓毒症患者的死亡率。在创建开放性腹部的同时使用刚性网持续牵拉腹壁是实现确定性腹壁闭合的关键步骤。因此，分期腹膜灌洗可能是治疗腹膜炎患者的一种较好的手术选择。
