[New approaches to the surgical treatment of diffuse peritonitis].
| Autor: | Brügger LE; Klinik für Viszerale und Transplantationschirurgie, Inselspital, Universität Bern., Seiler CA, Mittler M, Balsiger B, Feodorovici M, Baer HU, Büchler MW |
|---|---|
| Jazyk: | němčina |
| Zdroj: | Zentralblatt fur Chirurgie [Zentralbl Chir] 1999; Vol. 124 (3), pp. 181-6. |
| Abstrakt: | Objective: We intend to analyze if additional treatment concepts are necessary in any case as a part of the standard therapy next to the well established principle of source control in the treatment of secondary peritonitis. Design: A treatment concept with early intervention, source control and extensive intraoperative lavage (20-301) should be evaluated as a standard procedure in a prospective survey. Additional treatment concepts will be applied only for special reason (on demand). Results: From 11/1993 to 9/1997 241 patients with diffuse peritonitis were treated with the concept mentioned above. Additional treatment concepts as continuous postoperative lavage (n = 20) and staged lavage (n = 4) were applied as primary treatment in 24 patients only (10%), mainly for impossibility of source control and evisceration. Source control at the initial operation was possible in 216 patients (90%). Due to secondary evisceration 3 patients had to undergo laparostomy for staged lavage later. Severity of peritonitis was determined according to the Mannheim Peritonitis Index (median 26, range 15-43). The primary causes of peritonitis were perforation, leakage and abscess after operation (n = 56), followed by diverticular (n = 42) and gastric or duodenal perforation (n = 39). The hospital mortality rate was 14% in the whole group, and the postoperative morbidity rate was 39%. Conclusions: Due to progress in intensive care and antibiotic treatment only a few patients (ca. 10%) need additional therapies such as postoperative or staged lavage. Surgical source control in combination with intraoperative lavage is sufficient in most of the patients with diffuse peritonitis. |
| Databáze: | MEDLINE |
| Externí odkaz: |
|