Staged lavage versus single high-volume lavage in the treatment of feculent/purulent peritonitis: a matched pair analysis.
BACKGROUND
Spontaneous and iatrogenic secondary peritonitis remain to have a mortality of 10-30% and significant socioeconomic impact in survivors and especially non-survivors. Data on the most cost-effective treatment are lacking. We therefore studied outcome and resource utilization in a homogeneous cohort of patients with secondary fecal or purulent peritonitis undergoing surgery with source control and two different types of abdominal lavage.


METHODS
Thirty-one consecutive patients with secondary feculent or purulent peritonitis of the lower gastrointestinal tract underwent a single high-volume lavage. That cohort was matched with 31 patients with the same source, extent, and quality of peritonitis treated by source control and staged lavage (intermittent lavage).


RESULTS
Patients in both groups were comparable in gender distribution, age, comorbidity, source, extent, and severity of peritonitis with the history of intestinal perforation in the single high-volume lavage group being significantly higher than in the intermittent lavage group (2.0 +/- 1.7 vs. 1.1 +/- 0.8d; p = 0.008). Patients in the single high-volume lavage group had significantly less operations, thus requiring significantly less operation time (OR-time), intensive care unit (ICU)-requirement, ventilatory support, and inotropic support.


CONCLUSIONS
Patients with secondary fecal or purulent peritonitis in at least two quadrants, undergoing a one step surgical repair including source control, primary anastomosis, and single high-volume lavage with more than 25 l have a comparable outcome to patients treated by staged lavage at significantly lower OR and ICU-utilization.
Moussavian
Mohammed R
MR
Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, Homburg, Saarland, Germany.
Richter
Sven
S
Kollmar
Otto
O
Schuld
Jochen
J
Schilling
Martin K
MK
D000328:Adult; D000368:Aged; D003422:Critical Care; D005243:Feces; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007049:Iatrogenic Disease; D007416:Intestinal Perforation / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D007552:Isotonic Solutions; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D010533:Peritoneal Lavage / Q000379:methods* / Q000401:mortality; D010538:Peritonitis / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D000077325:Ringer's Lactate; D013492:Suppuration
D007552:Isotonic Solutions; D000077325:Ringer's Lactate