title: Scheduled relaparotomies using a zipper system for the treatment of diffuse generalized peritonitis in children.
abstract: In the treatment of diffuse peritonitis, planned relaparotomies with peritoneal lavages using a zipper system (EthiZip Ethicon) are sometimes necessary to obtain a complete eradication of the infectious focus. While most reported series are dealing with an adult population, this review focuses on the treatment of peritonitis using a zipper system in a paediatric age group. In a period of 3 years, insertion of a zipper device and peritoneal lavages were considered necessary to control intraabdominal sepsis in 7 children (age varying from 5 days to 13 years). They consequently underwent planned relaparotomies with peritoneal lavages every 24 to 48 hours. The peritonitis was caused by necrotizing enterocolitis (3 patients), postoperative complications (3 patients) and long existing perforated appendicitis (1 patient). Physical status, assessed by the Acute Physiologic Score (A.P.S.), varied from 12 to 22 (mean 17.7). Usually more than one lavage was necessary (1 to 3, mean 1.9) before the abdomen was considered clean and the zipper could be removed. Closure of the abdominal cavity could be achieved primarily in all cases. All patients survived. Although no statistically significant conclusions can be drawn from this small series and although it is unclear whether these children would not have survived without the zipper, this review shows that planned relaparotomies with peritoneal lavages using a zipper system can be performed safely even in very small children.
authors.affiliation: Department of Surgery, University Hospital, Antwerp, Belgium.
authors.forename: G
authors.initials: G
authors.lastname: Roeyen
authors.forename: G
authors.initials: G
authors.lastname: Hubens
authors.forename: W
authors.initials: W
authors.lastname: Vaneerdeweg
authors.forename: L
authors.initials: L
authors.lastname: Mahieu
authors.forename: E
authors.initials: E
authors.lastname: Eyskens
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007813:Laparotomy / Q000379:methods*; D010533:Peritoneal Lavage / Q000379:methods*; D010538:Peritonitis / Q000628:therapy*; D012086:Reoperation; D012307:Risk Factors; D013536:Suture Techniques; D016896:Treatment Outcome