title: Management of supra-mesocolic peritonitis using the Levy helicoid drain (Hélisonde®).
abstract: BACKGROUND
  Postoperative peritonitis arising in the upper abdomen requiring reoperative surgery has a mortality rate of up to 50%. One therapeutic modality for these patients is the use of the Hélisonde(®) drain, designed by Levy, the Levy Helical Drain (LHD), but it has not seen widespread use. In this paper, we describe our experience in managing supramesocolic peritonitis with this drain at the University Surgical Center at Amiens and we analyze our results.
  
  
  METHODS
  Between 2005 and 2010, we cared for 190 patients with supramesocolic peritonitis in our unit. Of these, 22 patients with gastric or duodenal fistula underwent transorificial intubation with the LHD. There were 12 men and 10 women with a mean age of 66 years. At surgery, the helical drain was screwed into the fistular orifice, two more flat drains were left adjacent to the fistula, and a jejunal feeding tube was placed. The mean interval between the initial surgery and the drainage procedure was 16.1 ± 14 days.
  
  
  RESULTS
  The mean APACHE II score was 20 (10-28). The Mannheim score averaged 28 (19-34). The LHD was completely removed at a mean interval of 35.5 ± 11 days. Six patients (27%) died postoperatively. Postoperative complications included intraperitoneal abscess (n = 3), pneumonia (n=1), and evisceration (n = 2). Two patients required reoperation. The average hospital stay was 70.7 days. Four patients had a persistent chronic fistula.
  
  
  CONCLUSIONS
  The LHD is a useful technical device in the treatment of supramesocolic peritonitis. Its management requires close oversight.
authors.affiliation: Service de chirurgie viscérale et digestive, CHU Nord-Amiens, université de Picardie, place Victor-Pauchet, 80054 Amiens cedex 01, France.
authors.forename: R
authors.initials: R
authors.lastname: Degremont
authors.forename: O
authors.initials: O
authors.lastname: Brehant
authors.forename: D
authors.initials: D
authors.lastname: Fuks
authors.forename: C
authors.initials: C
authors.lastname: Sabbagh
authors.forename: A
authors.initials: A
authors.lastname: Dhahri
authors.forename: F
authors.initials: F
authors.lastname: Browet
authors.forename: Y
authors.initials: Y
authors.lastname: Mahjoub
authors.forename: J-M
authors.initials: JM
authors.lastname: Regimbeau
mesh_terms: D018806:APACHE; D018784:Abdominal Abscess / Q000401:mortality / Q000601:surgery; D000368:Aged; D004322:Drainage / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000401:mortality / Q000601:surgery; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008646:Mesocolon / Q000601:surgery*; D008875:Middle Aged; D010538:Peritonitis / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome