[The therapeutic results of programmed relaparotomy in diffuse peritonitis].
The therapeutical concept of programmed relaparotomy was performed in 184 patients with diffuse peritonitis from 4/1984 to 4/1991. Clinical results were prospectively documented and a total of 46 variables (e.g. risk factors, clinical parameters, laboratory tests, microbiological screenings, score systems) both univariate and multivariate were tested for prognostic significance. Total lethality rate was 26% (48/184 patients). If complete eradication of the source of infection was surgically achieved (150 patients/82%) lethality rate was only 9%. In contrast, lethality rate was 100% in patients with unsuccessful surgical focus eradication. Eradication of the source of infection during the first operation (104 patients/56%) resulted in a lethality rate of 6%, compared to 17% for patients who needed two or even more operations (46 patients/25%). Eradication of the source of infection during the first laparotomy ("focus eradication on time") was the most important prognostic parameters. Of further prognostic significance but with declining importance where serum-creatinine at the beginning of the treatment, patient's age (greater than less than 70 years) and preexistent hepatic disease.
Bartels
H
H
Chirurgische Klinik, Klinikum rechts der Isar, München.
Barthlen
W
W
Siewert
J R
JR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005490:Focal Infection / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology; D015999:Multivariate Analysis; D010538:Peritonitis / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012044:Regression Analysis; D012086:Reoperation / Q000009:adverse effects / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
Therapie-Ergebnisse der programmierten Relaparotomie bei der diffusen Peritonitis.