Comparative analysis of outcome predictors in patients with postoperative peritonitis depending on the method of surgical treatment – relaparotomy on demand vs vacuum-assisted laparostomy
https://doi.org/10.35401/2541-9897-2022-25-4-24-31
Abstract
Background: Secondary postoperative diffuse peritonitis (SPDP) is one of the most severe complications of elective and emergency surgical interventions associated with a high mortality rate. To date, no optimal tactics of surgical treatment of SPDP has been developed.
Objective: The analysis of independent predictors of outcome depending on the method of surgical treatment – relaparotomy ondemand (RD) or vacuum-assisted laparostomy (VAL).
Material and methods: The study included 141 adult patients, male and female in the period from January 2014 to December 2020: group I (n = 63) – patients who received VAL method; group II (n = 78) – RD method. The method of multivariate logistic regression analysis was used to calculate the independent effects of potential predictor variables on the treatment outcome.
Results: The following independent predictors of treatment outcome in the RD group were identified: age, duration of hospital stay, number of relaparotomies, APACHE II score, Björck classification grade 1C at the 1st sanitation, bacteremia, Clavien–Dindo complications class 3a and 4a. For the VAL group: conversion of surgical tactics and bacteremia.
Conclusion: In patients with SPDP in the presence of risk factors for unfavorable outcomes, the use of VAL with staged sanitation of the abdominal cavity is indicated.
About the Authors
I. B. Uvarov
Kuban State Medical University;
Clinical Oncology Dispensary no. 1
Russian Federation
Russian Federation
Ivan B. Uvarov, Dr. Sci. (Med.), Associate Professor, Professor of the Department of Surgery no. 2, Faculty of Professional Training and Retraining of Specialists; Head of Oncology Department no. 3
4, Sedina str., Krasnodar, 350063
D. D. Sichinava
Clinical Oncology Dispensary no. 1
Russian Federation
Russian Federation
David D. Sichinava, Oncologist, Oncology Department no. 3
Krasnodar
A. M. Manuilov
Kuban State Medical University
Russian Federation
Russian Federation
Alexander M. Manuilov, Dr. Sci. (Med.), Professor, Head of the Department of Surgery no. 2, Faculty of Professional Training and Retraining of Specialists
4, Sedina str., Krasnodar, 350063
References
1. Ross JT, Matthay MA, Harris HW. Secondary peritonitis: principles of diagnosis and intervention. BMJ. 2018;361:k1407. PMID: 29914871. PMCID: PMC6889898. https://doi.org/10.1136/bmj.k1407
2. Clements TW, Tolonen M, Ball CG, et al. Secondary Peritonitis and Intra-Abdominal Sepsis: An Increasingly Global Disease in Search of Better Systemic Therapies. Scand J Surg. 2021;110(2):139–149. PMID: 33406974. https://doi.org/10.1177/1457496920984078
3. Sartelli M, Griffiths EA, Nestori M. The challenge of postoperative peritonitis after gastrointestinal surgery. Updates Surg. 2015;67(4):373–381. PMID: 26264821. https://doi.org/10.1007/s13304-015-0324-1
4. Balogh ZJ. Damage Control Surgery for Non-Trauma Patients: Severe Peritonitis Management. World J Surg. 2021;45(4):1053–1054. PMID: 33511423. https://doi.org/10.1007/s00268-021-05960-5
5. van Ruler O, Boermeester MA. Surgical treatment of secondary peritonitis: A continuing problem. Chirurg. 2017;88(Suppl 1):1–6. PMID: 26746213. PMCID: PMC5233781. https://doi.org/10.1007/s00104-015-0121-x
6. Avakimyan VA, Karipidi GK, Avakimyan SV, et al. Programmed relaparotomy in the treatment of general purulent peritonitis. Kuban Scientific Medical Bulletin. 2017;(6):12–16. (In Russ.). https://doi.org/10.25207/1608-6228-2017-24-6-12-16
7. Yadav S, Rawal G, Baxi M. Vacuum assisted closure technique: a short review. Pan Afr Med J. 2017;28:246. PMID: 29881491. PMCID: PMC5989194. https://doi.org/10.11604/pamj.2017.28.246.9606
8. Seternes A, Rekstad LC, Mo S, et al. Open Abdomen Treated with Negative Pressure Wound Therapy: Indications, Management and Survival. World J Surg. 2017;41(1):152–161. PMID: 27541031. https://doi.org/10.1007/s00268-016-3694-8
9. Polenok PV. Temporary closure of the abdominal cavity. Kuban Scientific Medical Bulletin. 2016;(1):112–115. (In Russ.). https://doi.org/10.25207/1608-6228-2016-1-112-115
10. Tartaglia D, Marin JN, Nicoli AM, et al. Predictive factors of mortality in open abdomen for abdominal sepsis: a retrospective cohort study on 113 patients. Updates Surg. 2021;73(5):1975–1982. PMID: 33683639. PMCID: PMC8500907. https://doi.org/10.1007/s13304-021-01012-8
11. Mayhew D, Mendonca V, Murthy BVS. A review of ASA physical status – historical perspectives and modern developments. Anaesthesia. 2019;74(3):373–379. PMID: 30648259. https://doi.org/10.1111/anae.14569
12. Krylov NN, Babkin OV, Babkin DO. Mannheim peritonitis index as a surgical criterion for perforative duodenal ulcer. Pirogov Russian Journal of Surgery. 2016;(7):18–22. (In Russ.). https://doi.org/10.17116/hirurgia2016718-22
13. Neri A, Fusario D, Marano L, et al. Clinical evaluation of the Mannheim Prognostic Index in post-operative peritonitis: a prospective cohort study. Updates Surg. 2020;72(4):1159–1166. PMID: 32578039. https://doi.org/10.1007/s13304-020-00831-5
14. Basile-Filho A, Lago AF, Menegueti MG, et al. The use of APACHE II, SOFA, SAPS 3, C-reactive protein/albumin ratio, and lactate to predict mortality of surgical critically ill patients: A retrospective cohort study. Medicine (Baltimore). 2019;98(26):e16204. PMID: 31261567. PMCID: PMC6617482. https://doi.org/10.1097/MD.0000000000016204
15. Sigua BV, Zemlyanoy VP, Petrov SV, et al. Surgical Aspects of the Treatment of Patients with Generalized Peritonitis. Russian Sklifosovsky Journal “Emergency Medical Care”. 2021;10(1):58–65. (In Russ.). https://doi.org/10.23934/2223-9022-2021-10-1-58-65
16. Björck M, Kirkpatrick AW, Cheatham M, et al. Amended Classification of the Open Abdomen. Scand J Surg. 2016;105(1):5–10. PMID: 26929286. https://doi.org/10.1177/1457496916631853
17. Kazaryan AM, Akopov AL, Rosok B, et al. Russian edition of the classification of complications in surgery. Grekov’s Bulletin of Surgery. 2014;173(2):86–91. (In Russ.). https://doi.org/10.24884/0042-4625-2014-173-2-86-91
Review
For citations:
Uvarov I.B., Sichinava D.D., Manuilov A.M. Comparative analysis of outcome predictors in patients with postoperative peritonitis depending on the method of surgical treatment – relaparotomy on demand vs vacuum-assisted laparostomy. Innovative Medicine of Kuban. 2022;(4):24-31. (In Russ.) https://doi.org/10.35401/2541-9897-2022-25-4-24-31
Views:
372
Email this article 
