[Complications of the management of secondary peritonitis with contained-open abdomen. Comparison of the Bogota's bag vs polypropylene mesh].
BACKGROUND
Surgery is the cornerstone regarding the treatment of secondary peritonitis, although the complications of the contained-open abdomen are common, and are usually severe.


OBJECTIVE
To identify the complications with the use of the "Bogotá's bag" compared with polypropylene mesh in contained-open abdomen. To identify other possible morbidity and mortality risk factors, independently of the mesh type usage.


METHODS
One hundred patients with secondary peritonitis were included in this retrospective cohort study. They were treated from January 2000 to March 2002. Fifty subjects were operated on with the "Bogota's bag " (50%) and 50 with the polypropylene mesh (50%). Mannheim's peritonitis severity index, complications and mortality using central tendency and dispersion means, the logistic regression analysis, prevalence and prevalence-ratios were analyzed.


RESULTS
Most frequent etiologies of secondary peritonitis were intestinal anastomosis dehiscence, hollow viscera perforation, and severe pancreatitis. Observed complications were: perforation and intestinal fistula in 13 cases (13%); 10 (20%) out of these belonged to the polypropylene mesh group, and 3 (6%) to the Bogota's bag group (p = 0.036). Evisceration was observed in 8 cases (8%); 2 (4%) in the polypropylene mesh group, and 6 (12%) in the Bogota's bag group (p = 0.140). Hemorrhage was present in 30 cases (30%); 16 (32%) in the polypropylene mesh group, and 14 (28%) in the Bogota's bag group (p = 0.662). Colonization was present in 24 cases (24%); and this was mainly evident in the polypropylene mesh group (p = 0.019). Mortality reached 42% (42 cases), and was associated to postoperative bleeding (p = 0.004), peritonitis' severity (p = 0.0012), and surgical reinterventions.


CONCLUSIONS
The contained-open abdomen is the best surgical option to treat infection and the compartmental abdominal syndrome in secondary peritonitis, however, complications may be relevant. These results demonstrated a direct relationship between peritonitis severity, the need for surgical re-interventions and mortality. The use of polypropylene mesh was related to an increased risk of intestinal fistulization and prothesis-associated infection.
García Iñiguez
José Antonio
JA
Servicio de Cirugía General y del Hospital de Especialidades de Centro Médico, Nacional de Occidente del Instituto Mexicano del Seguro Social.
Orozco
Clotilde Fuentes
CF
Muciño Hernández
María Ivette
MI
Ortega
Alejandro López
AL
Trabaldo
Stefano Sereno
SS
Cortés Flores
Ana Olivia
AO
Hermosillo Sandoval
José Manuel
JM
Ojeda
Alejandro González
AG
D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology / Q000601:surgery*; D011126:Polypropylenes / Q000627:therapeutic use; D011183:Postoperative Complications; D012189:Retrospective Studies; D013526:Surgical Mesh; D013536:Suture Techniques; D016896:Treatment Outcome
D011126:Polypropylenes