Laparostomy in patients with severe secondary peritonitis.
BACKGROUND
The aim of this study was to evaluate the effectiveness of laparostomy with the Bogota bag for the management of patients with severe secondary peritonitis and the risk factors for survival.


METHODS
Thirty-seven patients (22 males, 15 females; mean age 63.5; range 44 to 83 years) with secondary peritonitis were treated by laparostomy and temporary closure with Bogota bag. APACHE II scores and Mannheim Peritonitis Index (MPI) were used to calculate the disease severity. The outcomes and effectiveness of APACHE II and MPI values were analyzed retrospectively.


RESULTS
The mortality rate was 43.2%. Significant differences were noted between survivors and non-survivors according to initial APACHE II and MPI scores and the number of operations. The non-survivors had higher APACHE II (r=0.81, p=0.001) and MPI (r=0.39, p=0.02) scores. The patients who survived were re-operated 1.6 times and those who died were re-operated 4.7 times. In five patients, laparostomy was closed primarily, while in the others, the wound was left open to heal secondarily.


CONCLUSIONS
Patients with higher APACHE II and MPI scores and number of operations had higher rates of mortality due to their major risk factors. Temporary abdominal closure using the Bogota bag in patients with secondary peritonitis is an inexpensive-simple method, permitting evaluation of underlying viscera and recognition of infection.
Gönüllü
Doğan
D
Department of General Surgery, Taksim Training and Research Hospital, Istanbul, Turkey. dogangonullu@yahoo.com
Köksoy
Ferda Nihat
FN
Demiray
Okan
O
Ozkan
Sibel Gürdal
SG
Yücel
Tayfun
T
Yücel
Osman
O
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality*; D012086:Reoperation / Q000401:mortality* / Q000706:statistics & numerical data; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome