title: Deferred primary anastomosis versus diversion in patients with severe secondary peritonitis managed with staged laparotomies.
abstract: BACKGROUND
  There is inconclusive data on whether critically ill individuals with severe secondary peritonitis requiring multiple staged laparotomies may became eligible candidates for deferred primary anastomoses (DPA). We sought to compare a protocol for DPA against a protocol for diversion in severely ill critical patients with intra-abdominal sepsis.
  
  
  METHODS
  A retrospective cohort study was performed examining 112 patients admitted through an ICU between 2002 and 2006, with diagnosis of secondary peritonitis and managed with staged laparotomies whom required small- or large-bowel segment resections. Patients were categorized and compared according to the surgical treatment necessitated to resolve the secondary peritonitis (DPA versus diversion). Outcome measures were days on mechanical ventilation, days required in ICU, days required in hospital, incidence of fistulas/leakages, acute respiratory distress syndrome (ARDS), and mortality.
  
  
  RESULTS
  There were 34 patients subjected to DPA and 78 to diversion. Fistulas/leakages developed in three patients (8.8%) with DPA and four patients (5.1%) with diversion (p = 0.359). ARDS was present in 6 patients (17.6%) with DPA and 24 patients (30.8%) with diversion (p = 0.149). There were 30 patients (88.2%) with DPA and 65 patients (83.3%) with diversion discharged alive (p = 0.51). There were not statistical significant differences between groups among survivors regarding hospital length of stay, ICU length of stay, and days on mechanical ventilation.
  
  
  CONCLUSIONS
  We did not find significant differences in morbidity or mortality when we compared DPA versus diversion surgical treatment. It is feasible to perform a primary anastomosis in critically ill patients with severe secondary peritonitis managed with staged laparotomies.
authors.affiliation: Departamento de Cirugía, Fundación Valle del Lili, Carrera 98 No. 18-49, Cali, Colombia. carlosordonez@telecom.com.co
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Ordóñez
authors.forename: Alvaro I
authors.initials: AI
authors.lastname: Sánchez
authors.forename: Jaime A
authors.initials: JA
authors.lastname: Pineda
authors.forename: Marisol
authors.initials: M
authors.lastname: Badiel
authors.forename: Rafael
authors.initials: R
authors.lastname: Mesa
authors.forename: Uriel
authors.initials: U
authors.lastname: Cardona
authors.forename: Rafael
authors.initials: R
authors.lastname: Arias
authors.forename: Fernando
authors.initials: F
authors.lastname: Rosso
authors.forename: Marcela
authors.initials: M
authors.lastname: Granados
authors.forename: María I
authors.initials: MI
authors.lastname: Gutiérrez-Martínez
authors.forename: Juan B
authors.initials: JB
authors.lastname: Ochoa
authors.forename: Andrew
authors.initials: A
authors.lastname: Peitzman
authors.forename: Juan-Carlos
authors.initials: JC
authors.lastname: Puyana
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D002985:Clinical Protocols; D003105:Colombia / Q000453:epidemiology; D016638:Critical Illness; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome