ABSTRACT
Results of surgical treatment were analyzed in 65 patients with disseminated purulent peritonitis (DPP). 34 patients undergoing re-laparotomy "on demand" formed the first group. 31 patients undergoing programmed re-laparotomy formed the second group. Lethality was higher in the first group (59% compared with 29% in the second group; p = 0.024). Risk of lethal outcome was higher in 2.5 times in patients from the first group (p = 0.030). Survival rate was evaluated using APACHE II scale, but the distinctions between two groups were not statistically significant (p = 0.178). According to APACHE II scale high indices were observed in deceased patients from both groups (26.1 +/- 8.9 in the first group, 19.7 +/- 5.9 in the second group; p = 0.009). Indications for programmed planned abdominal cavity sanation and laparostoma surgery in patients with DPP are described. Authors suggest that programmed sanations substantially improve the results of treatment in patients with DPP compared with re-laparotomy "on demand".
Subject(s)
Laparotomy/methods , Peritonitis/surgery , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Peritonitis/mortality , Prospective Studies , Reoperation , Russia/epidemiology , Suppuration , Survival Rate/trends , Treatment OutcomeABSTRACT
Results of treatment of patients with acute pancreatitis are analyzed. Efficacy of staged treatment of patients with acute destructive pancreatitis is demonstrated. The ineffective conservative therapy during 1-3 days is regarded as indication for half-open surgical method (median laparotomy, necrsecvestrectomy, omentopancreatobursostoma and lumbostoma formation). General purulent peritonitis is indication for open method (laparostoma formation). Unitized surgical tactics permitted to reduce lethality from 4.2 to 2.5%.
