Closure of the abdominal cavity after severe peritonitis in bariatric surgery utilizing a mesh and plastic device.
The major cause of peritonitis in bariatric surgery is leakage of GI contents, which can have a catastrophic outcome for the bariatric patient. To resolve this serious problem, the surgeon must act quickly. This paper describes a 27-year-old female after gastric bypass with disruption of the gastroenterostomy and severe contamination and peritonitis. Closure of the anastomotic leak, drainage, and gastrostomy in the bypassed stomach were performed, but the abdomen could not be closed, due to dilated bowel and the intra-abdominal edema with the sepsis. Temporary laparostomy closure was performed; a plastic sheet with an overlying mesh was sutured to the fascial margins. Planned multiple reoperations permitted removal of necrotic and infected debris, with progressive approximation and ultimate closure of the fascia. This treatment resulted in a successful outcome for the patient.
de Menezes Ettinger
João Eduardo Marques Tavares
JE
Division of Bariatric Surgery, São Rafael Hospital, and Department of Surgery, Escola Bahiana de Medicina, Salvador, Bahia, Brazil. dr.ettinger@ig.com.br
Azaro
Euler
E
dos Santos Filho
Paulo Vicente
PV
Mello
Carlos Augusto Bastos
CA
Pereira
Antonio Jorge Barretto
AJ
Fahel
Edvaldo
E
D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D007583:Jejunum / Q000601:surgery; D010538:Peritonitis / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012828:Silicones; D013270:Stomach / Q000601:surgery; D013526:Surgical Mesh; D013529:Surgical Wound Dehiscence / Q000150:complications
D012828:Silicones