Complications of planned relaparotomy in patients with severe general peritonitis.
OBJECTIVE
To analyse the complications of planned relaparotomy for severe general peritonitis and to define when to discontinue relaparotomies.


METHODS
Retrospective study.


METHODS
University hospital, The Netherlands.


METHODS
24 consecutive patients who underwent planned relaparotomy for widespread faecal peritonitis caused by large bowel perforation (n = 15) or postoperative anastomotic leakage (n = 9).


METHODS
136 planned relaparotomies and 23 emergency laparotomies for intra-abdominal bleeding.


METHODS
Mortality, intra-abdominal complications, multiple organ failure (MOF) scores, and cultures of the abdominal cavity.


RESULTS
Seven patients died (29%). These patients had significantly higher MOF scores than survivors (p < 0.001) MOF scores did not change during the first seven days. Intra-abdominal complications were more common among those that died than survivors (p < 0.02) and correlated strongly with the number of planned relaparotomies (r = 0.90; p < 0.001). In all but three patients intra-abdominal cultures ceased to grow pathogens (< 10(3) cfu/ml microorganisms) after a median of 3 relaparotomies. Patients in whom fascial closure was achieved had undergone significantly fewer relaparotomies than those in whom it was not possible (P < 0.05).


CONCLUSIONS
Planned relaparotomy seems to be associated with appreciable morbidity and does not reverse organ dysfunction. The criterion of < 10(3) cfu/ml before cessation of planned relaparotomies might be useful.
van Goor
H
H
Department of Surgery, University Hospital Groningen, The Netherlands.
Hulsebos
R G
RG
Bleichrodt
R P
RP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003108:Colonic Diseases / Q000150:complications; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007239:Infections / Q000209:etiology; D007416:Intestinal Perforation / Q000150:complications; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D010538:Peritonitis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies