title: [Outcome of laparotomy for severe secondary peritonitis].
abstract: BACKGROUND
  Temporary abdominal closure with planned re-operations is a treatment method for several critical abdominal conditions. Aim of the study was to evaluate the effectiveness of laparostomy and the risk factors for survival in patients presenting with severe secondary peritonitis (SSP).
  
  
  METHODS
  52 patients (mean age 66.5) with a SSP were analyzed. The peritonitis developed spontaneously (n=34) or complicated a recent surgical operation (n=18). 18 patients were operated on for a bowel cancer and 6 of them had a metastatic disease. Skin closure (n=21), bogota bag (n=16) and vacuum-pack (n=15) were the methods employed to achieve temporary abdominal closure for planned re-operations. The severity of the disease was calculated by using APACHE II and Mannheim Peritonitis Index (MPI) scoring systems. Survival was the main outcome measure.
  
  
  RESULTS
  Mortality was 38% (n=20). Age, sex, pathogenesis of the peritonitis, type of temporary abdominal closure, number of re-operations and occurrence of entero-atmospheric fistula did not differ significantly between survivors and nonsurvivors. APACHE II (19.6 vs. 14.3; p=. 0015) and MPI (35.5 vs. 27.8; p=. 001) scores were significantly greater in the non-survivors group. The occurrence of perforated left colon/rectum was also significantly greater among non-survivors. By multivariate analysis only MPI resulted to be a significant independent risk factor for survival (p < 0.05).
  
  
  CONCLUSIONS
  SSP is a life-threatening condition. Laparostomy may have a role in controlling the source of abdominal infection but even with this outmost invasive surgical measure, mortality still remains high. For these patients, MPI may have a role as outcome predictor.
authors: Dipartimento di Chirurgia, Università di Pisa, Nuovo Ospedale Santa Chiara, Pisa, Italia. m.chiarugi@dc.med.unipi.it
authors: Massimo
authors: M
authors: Chiarugi
authors: Sonia
authors: S
authors: Panicucci
authors: Christian
authors: C
authors: Galatioto
authors: Mirene
authors: M
authors: Luciani
authors: Rudi
authors: R
authors: Mancini
authors: Monica
authors: M
authors: Cucinotta
authors: Chiara
authors: C
authors: Bagnato
authors: Mariangela
authors: M
authors: Mazzillo
authors: Elise
authors: E
authors: Pouli
authors: Massimo
authors: M
authors: Seccia
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010538:Peritonitis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome