title: [Laparotomy closure in advanced peritonitis].
abstract: OBJECTIVE
  to improve the results of advanced peritonitis management.
  
  
  METHODS
  743 patients with advanced peritonitis were studied. Patients were divided into 2 groups depending on treatment strategy.
  
  
  RESULTS
  Programmed relaparotomy combined with removable draining musculoaponeurotic seams during laparotomy closure decreased mortality from 47.8±2.7% to 24.1±2.3% (p<0.001) and provided 4-fold reduction of postoperative suppuration incidence (p<0.001). Refusal from removable draining musculoaponeurotic seams and use of only cutaneous seams in persistent abdominal hypertension were associated with further decrease of mortality to 15.8±2.7% (p<0.05).
  
  
  CONCLUSIONS
  Programmed relaparotomy combined with removable draining musculoaponeurotic seams are advisable for advanced peritonitis management. Laparotomy closure with only cutaneous seams is indicated in case of persistent abdominal hypertension. Large eventration always requires abdominal wall repair. APACHE-III scale scores have significant prognostic value in patients with advanced peritonitis.
authors.affiliation: Department of General Surgery, Kuban State Medical University, Krasnodar.
authors.forename: V M
authors.initials: VM
authors.lastname: Bensman
authors.affiliation: Department of General Surgery, Kuban State Medical University, Krasnodar.
authors.forename: Yu P
authors.initials: YP
authors.lastname: Savchenko
authors.affiliation: Department of General Surgery, Kuban State Medical University, Krasnodar.
authors.forename: S N
authors.initials: SN
authors.lastname: Shcherba
authors.affiliation: Research Institute - Ochapovsky Krasnodar Regional Clinical Hospital #1.
authors.forename: I V
authors.initials: IV
authors.lastname: Golikov
authors.affiliation: Research Institute - Ochapovsky Krasnodar Regional Clinical Hospital #1.
authors.forename: K V
authors.initials: KV
authors.lastname: Triandafilov
authors.affiliation: Research Institute - Ochapovsky Krasnodar Regional Clinical Hospital #1.
authors.forename: V V
authors.initials: VV
authors.lastname: Chaykin
authors.affiliation: Sochi City Hospital #4.
authors.forename: S N
authors.initials: SN
authors.lastname: Pyatakov
authors.affiliation: Ust-Labinsk Central Regional Hospital of Krasnodar Territoryk, Russia.
authors.forename: A S
authors.initials: AS
authors.lastname: Saakyan
authors.affiliation: Ust-Labinsk Central Regional Hospital of Krasnodar Territoryk, Russia.
authors.forename: E A
authors.initials: EA
authors.lastname: Saakyan
mesh_terms: D058107:Abdominal Wound Closure Techniques / Q000592:standards*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D010043:Outcome and Process Assessment, Health Care; D010533:Peritoneal Lavage / Q000009:adverse effects / Q000379:methods; D010538:Peritonitis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D011379:Prognosis; D012086:Reoperation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D012426:Russia / Q000453:epidemiology; D018805:Sepsis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control