Staged peritoneal lavages with the aid of a Zipper system in the treatment of diffuse peritonitis.
A major problem in the surgical treatment of diffuse peritonitis is to obtain a complete clearance of septic foci in the peritoneal cavity which may lead to persistence of sepsis and multiple organ failure. We describe our experience with staged abdominal re-explorations using a Zipper system in 23 patients with a mean APACHE II score of 20.3 (s.e.m: 1.5). A total of 91 lavages were done in these patients. Overall mortality was 39%. None of the patients having an APACHE II score between 10 and 20 died whereas the predicted mortality was 15%-45%. After successful treatment, primary closure was possible in 8 of the 14 surviving patients. Large incisional hernias developed in 6 patients. One patient eviscerated two years after complete granulation of his laparostoma. Staged abdominal re-explorations using a Zipper system is an useful tool in the treatment of diffuse peritonitis.
Hubens
G
G
Dept. of Surgery, Academic Hospital University of Antwerp, Belgium.
Lafaire
C
C
De Praeter
M
M
Ysebaert
D
D
Vaneerdeweg
W
W
Heytens
L
L
Eyskens
E
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004066:Digestive System Diseases / Q000150:complications; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010533:Peritoneal Lavage / Q000009:adverse effects / Q000379:methods*; D010538:Peritonitis / Q000209:etiology / Q000628:therapy*; D012086:Reoperation; D012720:Severity of Illness Index