Role Of Laprostomy In Septic Abdomen Cases

Abstract

Abstract: Background: The fundamental principles of management of severe peritonitis include general supportive management, antibiotic therapy, and prompt surgical intervention. Surgical intervention includes source control, peritoneal toileting, and Prevention of recurrent infection. The definitive closure of the abdominal wall, i.e., a closure of the fascial layer and skin may not be favourable in the treatment of numerous surgical conditions, e. g., peritonitis, trauma, or mesenteric ischemia. In these cases, the abdominal wall is temporarily closed. And a Laprostomy is created to facilitate re-exploration or to prevent abdominal compartment syndrome. Objectives: To study the role of laprostomy in septic abdomen cases and to evaluate the importance of laprostomy in septic abdomen cases in rural hospital setup.Methods: Patients admitted with severe peritonitis where managed with prompt surgical intervention, 25 cases abdomen wall has been closed primarily and other group 25cases had undergone laprostomy, patients has been monitored post operatively and assessed by APACHE II. Results: Laprostomy patients had greater postoperative recovery and decrease in septicaemia when compared to primary closure. Conclusion: Laprostomy facilitates re-intervention, Prevents and treats persistent / recurrent infections, Avoids increased intra-abdominal pressure. Lastly, the risk of abdominal compartment syndrome is virtually eliminated. Background: The fundamental principles of management of severe peritonitis include general supportive management, antibiotic therapy, and prompt surgical intervention. Surgical intervention includes source control, peritoneal toileting, and Prevention of recurrent infection. The definitive closure of the abdominal wall, i.e., a closure of the fascial layer and skin may not be favourable in the treatment of numerous surgical conditions, e. g., peritonitis, trauma, or mesenteric ischemia. In these cases, the abdominal wall is temporarily closed. And a Laprostomy is created to facilitate re-exploration or to prevent abdominal compartment syndrome. Objectives: To study the role of laprostomy in septic abdomen cases and to evaluate the importance of laprostomy in septic abdomen cases in rural hospital setup.Methods: Patients admitted with severe peritonitis where managed with prompt surgical intervention, 25 cases abdomen wall has been closed primarily and other group 25cases had undergone laprostomy, patients has been monitored post operatively and assessed by APACHE II. Results: Laprostomy patients had greater postoperative recovery and decrease in septicaemia when compared to primary closure. Conclusion: Laprostomy facilitates re-intervention, Prevents and treats persistent / recurrent infections, Avoids increased intra-abdominal pressure. Lastly, the risk of abdominal compartment syndrome is virtually eliminated. INTRODUCTION The fundamental principles of management of severe peritonitis include general supportive management, antibiotic therapy, and prompt surgical intervention. Surgical intervention includes source control, peritoneal toileting, and Prevention of recurrent infection. The definitive closure of the abdominal wall, i.e., a closure of the fascial layer and skin may not be favourable in the treatment of numerous surgical conditions, e. g., peritonitis, trauma, or mesenteric ischemia. In these cases, the abdominal wall is temporarily closed. And a Laprostomy is created to facilitate reexploration or to prevent abdominal compartment syndrome. It is defined as the sudden increase in the intra-abdominal pressure to more than 25cm of water resulting in alteration in the respiratory mechanism, hemodynamic parameters, and renal as well as cerebral perfusion. Severe intra-abdominal sepsis requires Laprostomy and at least ventilator and cardiovascular support. The “open” abdomen has gained popularity in the management of severe intraabdominal sepsis. Drawbacks include evisceration, need for ventilator support, and recurrent abdominal sepsis. We have applied a more aggressive and effective technique consisting of abdominal “closure” with a sheetmade of medical grade soft and transparent PVC sheet (urobag). Temporary abdominal closure using this method is an inexpensivesimple method, permitting evaluation of underlying viscera and recognition of infection and prevention of abdominal compartment syndrome. METHODS Fifty patients (30males,20females,mean age 52.8years – range24 to 80 years) with secondary peritonitis were surgically treated.25 patients were managed with primary closure of the abdomen and the other 25 patients were managed with closed laprostomy with a soft sheet made of medical grade transparent PVC sheet(urobag), sterilised by ETO gas. Post operatively patients were assessed by APACHE II.The outcomes and effectiveness were analysed retrospectively between primary closure and laprostomy patients. The role of laprostomy-need for relook, peritoneal toileting and its merits, demerits were assessed in rural hospital setup. Period of study: one year. Role Of Laprostomy In Septic Abdomen Cases 2 of 6 Approval obtained from Ethical committee. Inclusion criteria: all age group, all secondary peritonitis cases. Exclusion criteria: primary peritonitis, severe co-morbid conditions.