A comparison of patients who have appendectomy during the COVID-19 pandemic period with the period before the pandemic.

BACKGROUND: This study aims to compare the waiting and operating times of the patients who applied to our hospital with the diagnosis of acute appendicitis (AA) during the pandemic, how the process was managed in terms of AA and other data of the patient compared to the pre-pandemic period. METHODS: A retrospective cohort analysis was performed among patients who were hospitalized in the Fatih Sultan Mehmet Training and Research Hospital General Surgery Clinic with a pre-diagnosis of AA. For this purpose, two groups were formed. Group 1: It comprised patients who were operated between March 11 and June 1, 2020; Group 2: It comprised patients who were operated between March 11 and June 1, 2019, with a pre-diagnosis of AA. RESULTS: Forty-six patients in Group 1 and 79 patients in Group 2 were operated with the pre-diagnosis of AA. There was no difference between groups in terms of pre-operative symptom durations or surgery waiting times. CONCLUSION: During the COVID-19 pandemic, significant decrease observed in the number of patients operated because of AA can be interpreted as the avoidance of patients from applying to the hospital with the concern of infection. Moreover, it may suggest that uncomplicated cases undergo spontaneous resolution; however, there is a requirement for further research to support this assumption and define the criteria for this condition by including a level of scientific evidence.

Effectiveness of local anesthetic application methods in postoperative pain control in laparoscopic cholecystectomies; a randomised controlled trial.

BACKGROUND: Laparoscopic cholecystectomy is a minimally invasive procedure that causes pain originating from parietal and visceral peritoneum. Many studies have been conducted to improve postoperative pain management and comfort of patients. Various methods such as local anesthetic injection (LAI) at trocar access points, intraperitoneal local anesthetic injection (IPLA), pneumoperitoneum pressure reduction, transversus abdominis plane block (TAPB), and reducing the number of trocars used during the operation were attempted to reduce postoperative pain. METHODS: In this study, we compared LAI, TAPB and IPLA methods with the control group in which no local anesthetic was applied to reduce postoperative pain after laparoscopic cholecystectomy. We also demonstrated the effect of these methods on postoperative pain, need for additional analgesics, length of hospitalization, and patient satisfaction. RESULTS: Overall, 160 patients aged 18-74 years who underwent laparoscopic cholecystectomy for cholelithiasis between October 2018 and August 2019 were included in the study and divided into four groups as follows: LAI group, TAPB group, IPLA group, and the control group without any intervention. Visual Analog Scale (VAS) values at 1, 2, 4, 6, 12, and 24 h in the control group were significantly higher than in the LAI, TAPB, and IPLA groups. Further, VAS values at 1, 2, 4, 6, 12, and 24 h in the IPLA group were significantly higher than in the LAI and TAPB groups. No significant difference was observed between the LAI and TAPB groups in terms of VAS values at 1, 2, 4, 6, and 24 h. VAS values at 12 h in the LAI group were significantly higher than in the TAPB group. CONCLUSIONS: Peroperative local anesthetic administration methods were more effective in preventing pain after laparoscopic cholecystectomy compared to the control group. In addition to reducing postoperative pain, these methods reduced the need for postoperative analgesics and increased patient satisfaction.

Effective use of CT by surgeons in acute appendicitis diagnosis.

BACKGROUND: Acute appendicitis (AA) still maintains its prominence among general surgical emergencies, and the risk of developing AA is 8.6% for men and 6.7% for women. The clinical diagnosis of acute appendicitis has a rate of approximately 20% false positive and false-negative. Ultrasound (US) and Computed Tomography (CT) are the imaging methods most utilized in this field. The present study aims to determine the relationship between the evaluation results of the clinician who examined the patient and the radiologist's evaluation in the evaluation of cross-sectional imaging tests for the diagnosis of acute appendicitis. METHODS: In this study, the records of 1891 patients who underwent an appendectomy in the General Surgery Clinic of Fatih Sultan Mehmet Training and Research Hospital between January 2010 and 2017 were reviewed retrospectively. From the file of the patients who underwent appendectomy with acute appendicitis and whose appendix was reported as normal in CT results, clinical examination findings of the patient in the emergency department and CT evaluation results of the relevant surgeon (Compatible with acute appendicitis, normal appendix or appendix could not be visualised) were recorded. RESULTS: Of the 1891 patients, who underwent appendectomy on suspicion of acute appendicitis, 1478 had CT scans for diagnosis and 145 were reported as normal by radiologists. In the evaluations by surgeons of these CT results all reported as normal by radiologists, 105 (%) 72,4) were compatible with acute appendicitis, while 18 (12.4%) were considered normal. In 22 (15.2%) patients, appendix could not be the visualized by surgeons. 70.0% of the cases with Lymphoid hyperplasia - fibrous obliteration pathology result; 73.8% of the cases with acute appendicitis; 75.6% of those with phlegmonousappendicitis and 64.0% of those with gangrenous/perforated appendicitis were diagnosed as appendicitis by CT evaluation performed by a general surgeon. CONCLUSION: Diagnostic accuracy rates increase significantly when the CT results are interpreted by the physician performing the clinical evaluation of the patient. The chance of reaching the correct diagnosis will increase with gaining the ability to interpret abdominal cross-sectional imaging techniques during general surgery specialty training.

Clinical approach to patients admitted to the emergency room due to acute cholecystitis during the COVID-19 pandemic and percutaneous cholecystostomy experience.

BACKGROUND: Acute cholecystitis (AC), a common complication of gallstones, is responsible for a significant part of emergency applications, and cholecystectomy is the only definitive treatment method for AC. Early cholecystectomy has many reported advantages. Operation-related morbidity and mortality have increased during the COVID-19 pandemic. In this study, our aim is to present our general clinical approach to patients who were diagnosed with AC during the pandemic and our percutaneous cholecystostomy experience during this period. METHODS: This study included 72 patients who were presented to our hospital's emergency room between March 11 and May 31, 2020, with AC. Patients were divided into three groups based on their treatment: outpatients (Group 1), inpatients (Group 2) and patients undergoing percutaneous cholecystostomy (Group 3). These three groups were compared by their demographic and clinical characteristics. RESULTS: There were 36 (50%) patients in Group 1, 25 (34.7%) patients in Group 2, and 11 (15.3%) patients in Group 3. The demographic characteristics of the patients were similar. The CRP and WBC levels of the patients in Group 3 were significantly higher compared to the other groups. Moreover, the wall of the gallbladder was thicker and the size of the gallbladder was larger in Group 3. Patients had percutaneous cholecystostomy at the median of 3.5 days and the length of hospital stay was longer compared to Group 2 (3.9 days versus 9.2 days, p=0.00). The rate of re-hospitalization after discharge was similar in Group 2 and Group 3, but none of the patients in Group 1 required hospitalization. None of 72 patients developed an emergency condition requiring surgery, and there was no death. CONCLUSION: Although many publications emphasize that laparoscopic cholecystectomy (LC) can be performed with low morbidity at the first admission in acute cholecystitis, it is a clinical condition that can be delayed in the COVID-19 pandemic and other similar emergencies. Thus, percutaneous cholecystostomy should be effectively employed, and its indications should be extended if necessary (e.g., younger patients, patients with lower CCI or ASA). This approach may enable us to protect both patients and healthcare professionals that perform the operation from the risk of COVID-19.

Fallopian tube herniation from trocar-site after laparoscopic appendectomy.

Trocar site hernias are a type of incisional hernias and may occur within a variable time shift after surgery. A mean incidence of 1.85% was reported, and the first trocar site hernia was narrated by Maio et al. in 1991 describing small bowel obstruction due to trocar site herniation after laparoscopic cholecystectomy. The 10-mm-trocar port is more frequently problematic, and a trocar site hernia in 5 mm port is very rare. This report unveils a 5mm trocar site herniation of right fallopian tube following laparoscopic appendectomy. In this case study, a 19-year-old female patient applied to the emergency department because of a discharge in the right lower quadrant was reported. She explained that she had undergone laparoscopic appendectomy two days before and discharged the next day uneventfully. The surgical report described a suction drain in the right lower quadrant where the patient was suffering from the discharge. The physical examination revealed no tenderness, but an abdominal CT disclosed an edematous tubular structure herniating from the 5 mm trocar site where the drain was put. She was re-operated laparoscopically due to early trocar site hernia, and the right fallopian tube was observed herniating through the defect. After the reduction into the abdomen, the fallopian tube was observed fine, and the defect was closed using 2/0 polypropylene suture. Trocar site hernias are rare but may cause serious complications after laparoscopic surgery. They may occur early after the surgery, but the time shift is variable. Although mechanical bowel obstructions are more frequent endpoint, it should be remembered that any organ within the abdominal cavity may herniate.

Strangulated inguinal hernia accompanied by paratesticular leiomyosarcoma.

Sarcomas that arise from the spermatic cord constitute 2.1% of soft tissue sarcomas and are observed at a rate of 1% to 2% in the genitourinary system. A 74-year-old patient presented at the emergency department with complaints of groin pain and swelling persisting for 3 days. On physical examination, a firm mass that was approximately 5x5 cm in size and could not be reduced was observed at the right inguinal area as well as a right inguinal hernia. Computed tomography revealed a large hernia sac in the right inguinal area and a mass that was 77x55 mm in size within the hernial sac. A radical orchiectomy and hernia repair were performed. A diagnosis of leiomyosarcoma was made based on the pathological evaluation of the mass. At the 7-month postoperative follow-up, no local relapse or distant metastasis was found. To conclude, although paratesticular leiomyosarcoma is rare, it should be kept in mind as one of the possible diagnoses for older patients presenting with an inguinal mass.

Early results of comparison of polypropylene mesh and 75% resorbable mesh (monofilament polypropylene and poly-L-lactic acid (PLLA) mesh) for laparoscopic total extraperitoneal (TEP) inguinal hernia repair.

OBJECTIVE: Laparoscopic totally extraperitoneal (TEP) hernia repair has become increasingly widespread. Faster recovery than conventional open methods shortens the return to work. Polypropylene (PP) mesh is still in use in hernia surgery because it is an inexpensive and easily accessible patch. The post-operative chronic pain and foreign body sensation are the disadvantages of these PP patches. Poly-L-lactic acid and polypropylene (PLLA) were used in this study because of the good biocompatibility and low tissue inflammation response. We compared the early clinical outcomes of PP patch and PLLA patches. METHODS: Between January 2013 and April, 2018,469 patients with inguinal hernia underwent TEP procedure. Patients were divided into two groups. PP mesh (n=211) in group 1, PLLA mesh (n=258) in group 2. Patients were compared regarding age, gender, hernia side, ASA scores, the duration of operation, pain, time to return to work, the sensation of foreign body, seroma and hematoma. RESULTS: A total of 469 patients were analyzed retrospectively (426 male, 43 female). The mean age was 52.23±13.66 years. The operative times of the patients were 40.92±8.9 minutes in group 1, and 38.82±8.5 minutes in group 2 (p<0.05). The time to return to work was 10.2±1.47 days in Group 1 and 8.4±1.0 days in Group 2 (p<0.05). Visual Analog Scale (VAS) in group 2 was lower than in group 1 (p<0.005). In group 2, the feeling of the organic body decreased in the early and late period (p<0.005). Seroma and hematoma were less in Group 2 than in Group 1 (p<0.005). The mean follow-up period of the patients was 18 (3-63) months, two patients in Group 1, two patients in Group 2 recurred. CONCLUSION: The PLLA patch used in the TEP method is thought to be a herniated patch that can be safely used because of its ease of application and less postoperative complication rates and more rapid return to work.

The antibacterial effect of peritoneal fluid in experimental peritonitis.

BACKGROUND: In our study, the effects of peritoneal fluid on some Gram-negative and Candida albicans in experimental peritonitis rats were studied. The primary objective of the present study was to understand the effect of peritoneal fluid on microorganisms causing intra-abdominal infections. METHODS: Twenty male Sprague-Dawley rats weighing between 250 and 300 g were used in the study. The rats were randomly divided into two groups consisting of 10 animals. The operative procedures were performed under sterile conditions. In group I, sham laparotomy was done. In group II, the distal part of the cecum was ligated, and cecum perforation was performed. Peritoneal fluid samples at baseline and 2 and 4 h were extracted using a Pasteur pipette during laparotomy under anesthesia. RESULTS: Peritoneal fluid was ineffective on Citrobacter freundii, Proteus mirabilis, and Enterobacter aerogenes. It inhibited the growth of Klebsiella pneumoniae for 8 h. However, growth was significantly increased in the passages obtained after 24 h. The growth of C. albicans decreased in the passages that were extracted after 4 and 8 h and increased in the passages obtained after 24 h (p<0.05). It was found that the number of Escherichia coli and Pseudomonas aeruginosa colonies that were grown in 2 h decreased, and no growth was detected in the passages obtained after 2 h (p<0.05). CONCLUSION: Proliferating colony counts of E. coli and P. aeruginosa decreased after 2 h, and there was no proliferation in subsequent cultures. Peritoneal fluid exhibits a bactericidal effect under appropriate conditions. It also exhibits peritoneal bactericidal activity against E. coli, the major pathogen in intra-abdominal infections.

Spontaneous rupture of the splenic artery aneurysm: a rare clinical presentation of acute abdomen.

Splenic artery aneurysms are very rare causes of acute abdomen but are important to recognize since they carry high rate of mortality when ruptured. The aim of this study was to present a middle aged man with sudden onset of abdominal pain. Being previously on steroid treatment due to sarcoidosis, the patient developed hypovolemic shock during work-up in diagnostic imaging and went on emergency laparatomy. The source was identified as a ruptured splenic artery aneurysm. Splenectomy en bloc with the aneurysmatic distal splenic artery was performed, and he was discharged uneventfully. Despite rare, it is important to recognize splenic artery aneurysm in the emergency department, and immediate intervention is required to save the patient.

Should appendectomy be performed laparoscopically? Clinical prospective randomized trial.

OBJECTIVE: Laparoscopic appendectomy (LA) has been described in 1983, and its superiority over open appendectomy (OA) is still being debated. Currently, there is no agreement on the advantages of LA. Postoperative pain is reported to be lower along with a faster return to normal activities in LA. However, some studies do not support these findings. In our study, we aimed to compare the outcomes and cost effectiveness of LA and OA. MATERIAL AND METHODS: Patients were prospectively randomized into LA (31 patients) and OA (32 patients) groups. Demographic data, pre- and postoperative C-reactive protein (CRP) levels, white blood cell (WBC) count, duration of surgery and hospitalization, complications, and pain scores (VAS) were recorded. Cost was calculated for both groups. Return to normal activities was evaluated by phone calls at the first and second week and 1 month after surgery. RESULTS: There was a significant postoperative decrease in WBC count in the LA group (p<0.01). There were no differences between LA and OA groups in terms of postoperative CRP levels (p>0.05). The rates of wound infection and abscess were similar (p>0.05), while post-operative pain and time to return to normal activities were higher in the OA group (p<0.01). There was a positive correlation between BMI and operative time in the LA group (p<0.01), while BMI and operative time did not show a correlation in the OA group (p>0,05). The average cost in the LA and OA groups were 1960.5±339.05 and 687.115±159.5 TL, respectively. CONCLUSION: LA is an effective method in the treatment of acute appendicitis due to less pain and faster recovery. LA can be the choice of treatment in acute appendicitis, with utilization of re-useable and cheaper vascular sealing devices.

[A rare cause of small intestinal obstruction: Spontaneous strangulated trans-omental hernia]. / Nadir bir ince bagirsak tikaniklik nedeni: Spontan strangüle transomental fitik.

Internal herniation is a very rare condition which can cause small bowel obstruction. Trans-omental hernias are an infrequent form of internal herniation and can be seen without a history of trauma and previous abdominal surgery. An 85-year-old male patient without a history of abdominal surgery or trauma was admitted to the emergency service with severe abdominal pain and vomiting. Physical examination and laboratory tests revealed a diagnosis of ileus. During laparotomy, a trans-omental hernia causing strangulation of the ileum was detected. Resection-anastomosis was performed and the omental defect was disrupted by partial omentectomy. Although trans-omental hernia is a very rare condition, it should be considered in the differential diagnosis of patients without mechanic intestinal obstruction.

Difficulties of bariatric surgery after abdominoplasty.

During laparoscopy, the main problems of patients who have undergone previous abdominoplasty are inadequate pneumoperitoneum secondary to fibrosis and reconstructed anatomic landmarks for trocar placement. In this study, we present our laparoscopic bariatric experience in two patients with previous abdominoplasty. The procedures were a laparoscopic sleeve gastrectomy and a robotic Roux-en-Y gastric bypass. Both operations were done successfully by an abdominal wall traction technique, cutting fibrotic tissue and choosing new landmarks. We conclude that after abdominoplasty bariatric surgery can be performed safely either using conventional laparoscopic technique or robotically.

Pneumoperitoneum with subcutaneous emphysema after percutaneous endoscopic gastrostomy.

Percutaneous endoscopic gastrostomy is a safe way for enteral nutrition in selected patients. Generally, complications of this procedure are very rare but due to patients general health condition, delayed diagnosis and treatment of complications can be life threatening. In this study, we present a PEG-related massive pneumoperitoneum and subcutaneous emphysema in a patient with neuro-Behçet.

The effect of the endoscopist on the wait-time for colorectal cancer surgery.

OBJECTIVE: The effect of the specialty of physicians who perform endoscopy on preoperative wait-time of colorectal cancer patients was evaluated. MATERIAL AND METHODS: Data from 86 patients who have been operated with a diagnosis of colorectal cancer from January 2011-February 2013 regarding age, sex, tumor location, colonoscopy date, surgery date, the expertise and institution of the endoscopist were retrospectively examined. The time between colonoscopy and surgery was accepted as the pre-operative wait time (PWT). RESULTS: Out of 86 patients, 24 (27.9%) colonoscopies were performed by general surgeons (GS), and 62 (72.1%) by gastroenterologists (GE). When patients who underwent colonoscopy in other centers were extracted, the PWT for our center was 20.4±10.8 days. When grouped according to specialties, the PWT of patients who had their colonoscopy performed by GS was significantly shorter than patients who underwent colonoscopy by GE at the same center (p<0.05). Patient's age, sex and location of the tumor had no effect on PWT (p>0.05). CONCLUSION: The preparation time for surgery in colorectal cancer patients is influenced by the specialty of the physician performing the procedure. In order to standardize this period, a common flow diagram after endoscopy should be established for patients with suspected malignancy.

Effects of intra-abdominal pressure increase on intestinal ischemia and bacterial translocation in experimental sepsis model.

OBJECTIVE: To investigate the safety of laparoscopic intervention for diagnosis and treatment at 8 mm Hg pressure in one-hour period on acute peritonitis related intra-abdominal sepsis model. METHODS: In this study, we included 32 female Wistar-Albino rats, weighing 250 +/- 20 g, and divided them into 4 groups. This study was conducted in Istanbul University Experimental Medical Research Institution (DETAE) laboratory from April to May 2009. Intra-abdominal sepsis was created with intraperitoneal (i.p.) one mL (109 CFU/mL) Escherichia coli (E. coli) injection, and pneumoperitoneum was formed with CO2 insufflation at 8 mm Hg pressure for one hour i.p. The rats were administered with: Group 1 - one mL i.p. isotonic saline; Group 2 - one mL i.p. isotonic saline + pneumoperitoneum; Group 3 - i.p E. coli; and Group 4 - i.p. E.coli + pneumoperitoneum. Data were analyzed using the Statistical Package for Social Sciences version 15 for Windows (SPSS Inc, Chicago, IL, USA). RESULTS: Fever and leukocyte values were considered high in Groups 3 and 4 compared with Groups 1 and 2 (p=0.001). The administered reproduction ratio of the E. coli strain was determined as 0% in Groups 1 and 2, and 100% in Groups 3 and 4. CONCLUSION: In this study, as pneumoperitoneum was formed for one hour at 8 mm Hg pressure, in case of intra-abdominal derived sepsis where emergency intervention is needed, we consider that laparoscopic approaches with low pressure may be used safely for diagnosis and treatment.

Comparison of repair techniques in rat duodonal perforations: simple closure, simple closure and omentoplasty, and fibrin tissue adhesive.

BACKGROUND: We compared three repair techniques, namely, simple closure and omentoplasty, simple closure alone, and fibrin tissue adhesive, in the treatment of rat duodenal perforations induced in the postpyloric region. METHODS: Thirty male Sprague-Dawley rats (210-240 g) were included. Under ketamine and ether anesthesia, duodenal perforations of 2 mm were induced in all rats in the postpyloric region. The rats were assigned to three groups equal in number, which underwent repair with the use of simple closure and omentoplasty, simple closure alone, and fibrin glue, respectively. All the animals were sacrificed under deep ether anesthesia on the fourth postoperative day. To assess wound strength, bursting pressure measurements were performed. In addition, hydroxyproline content of the wound site was measured by absorbance spectrophotometry at 560 nm. RESULTS: The mean bursting pressure in the simple closure and omentoplasty group was significantly higher than those of the simple closure (p<0.05) and fibrin glue (p<0.001) groups. No significant difference existed between the simple closure and fibrin glue groups in this respect (p>0.05). Hydroxyproline values of the simple closure and omentoplasty (p<0.05) and simple closure (p<0.001) groups were significantly lower than that of the fibrin glue group. CONCLUSION: Fibrin tissue adhesives may have an application in the treatment of duodenal ulcer perforations, as an adjunct to laparoscopic or open surgical methods.

[STAGED ABDOMINAL REPAIR (STAR) PROCEDURES IN OUR CLlNIC]. / KLINIGIMIZDE ASAMALI ABDOMINAL ONARIM (STAR) UYGULAMALARI.

AIM: In this study we assessed the results of staged abdominal repair (STAR) applications in our clinic. METHODS: Retrospective analysis ofsix cases who were operated by staged abdominal repair (STAR) between December 1998-1January 2002 were assessed according to operation indications, type of operation, presentation ofthe complications and mortality. RESULTS: The initial operations for two ischemic bowel disease cases were right hemicolectomy + end ileostomy + mucous fistula and partial small bowel resection + right hemicolectomy + ileotransversostomy. The operative indications were fistula formation following strangulatedfemoral hernia, diverticular perforation, diverticulitis + massive lower gastrointestinal bleeding and abdominal ! gunshot trauma, and operations were right hemicolectomy + ileotransversostomy, subtotal colectomy + ileorectostomy + diverting ileostomy, subtotal colectomy + Hartmann procedure and primary repair of vena cava + distal pancreatectomy + left hemicolectomy+ Hartmann procedure respectively. Median hospital stay was 28 days. Two cases had pulmonary problems (pleural effiision and 1 atelectasis). Gunshot trauma patient died four days after the abdominal closure probably due to pulmonary emboli. CONCLUTIONS: Relaparotomy decision may be made prior to the operation but the final decision is made per-operatively. Staged abdominal repair gives an opportunity for sufficient debridement and peritoneallavage and also gives a chance to evaluate the anastomosis sites.

[The effect of antibiotic therapy on lung pathology in experimental models of sepsis]. / Deneysel sepsis modelinde akciger patolojisi ve antibiyotiklerin etkisi.

AIMS: In this study, the effect of an extra-lung sepsis model on lung histopathology is evaluated. METHODOLOGY: In this study 20 Wistar-Albino rats were used. Following the ether anesthesia laparotomy was done. Caecum was ligated by a silk thread and was perforated by 18 gauge needle. It is squeezed until feces emerged. Abdominal wall is closed. By this method peritoneal sepsis was performed. The rats are divided into two groups (n:10). 0.5 ml of serum physiologic is applied to the control group, and imipenem is applied to the antibiotic group as 15 mg/kg/tid. 48 hours later rats were sacrificed by extreme ether anesthesia. Relaparatomy was done and diaphragm was open. Multiple biopsies were made from the lung. Biopsy materials was cultured and examined histopathologically. RESULTS: In control group; rats died in 48 hours (%100), but antibiotic group were alive (%0). The results of lung biopsy cultures are; in all rats in control group, Escherichia coli (E. coli) and Bacteroides fragilis (B. fragilis) were cultured (%100). Whereas in antibiotic group there is no bacteria cultured (p < 0.001). Histopathologic results are: in control group there was wide spread edema and congestion and inflammatory reaction. In antibiotic group there was slight edema, congestion and inflammatory reaction. CONCLUSION: In septic condition sings of adult respiratory distress syndrome occurs. Large spectrum antibiotics can prevent bacterial translocation in lungs and could minimize the lung injury.

[Importance of source control in secondary peritonitis]. / Sekonder peritonitlerde kaynak kontrolünün önemi.

AIMS: In this study we discussed retrospectively secondary peritonitis patients, surgical treatment modalities and their effectiveness in our clinic. MATERIALS & METHODOLOGY: 91 patients were operated due to diffuse peritonitis between December 1998 through July 2001 in our clinic were analysed by age, sex, etiology of peritonitis, treatment modalities, morbidity and mortality. RESULTS: 32 patients were female (35.2%) and 59 patients were male (64.8%). The median age was 40.4. The most common etiologic factor for secondary peritonitis is peptic ulcus perforation (38.4%). 23 cases (25.2%) had the diagnosis only by physical examination and laboratory assessment. The other cases diagnosed with roentgenographic evaluation. In the first operation, the aim was the source control and eradication. In 3 cases, planned re-laparotomy "staged abdominal repair" (STAR) were performed. Conservative treatment modality was performed for 8 cases. The median hospital stay for the patients were 7.4 day. Morbidity was encountered in 13 (13.6%) and mortality was encountered in 2 (2.1%). CONCLUSION: Source control must be the primary aim of the first operation for secondary peritonitis patients. If there is an uncertainty for source control, STAR procedure should be the choice of the treatment modality for decrease morbidity and mortality.