System of choice of surgical approach and option to complete laparotomy in generalized peritonitis

Abstract

In modern surgery, there are three options that are used to complete laparotomy after performing the main stage of the operation for peritonitis: 1. closed method, in which the wound of the anterior abdominal wall is tightly sutured after drainage of the abdominal cavity, 2. staged planned operations planned relaparotomy), 3. open abdomen technique — laparostomy. Meanwhile, the criteria for choosing one or another option for completing a laparotomy are contradictory (especially when selecting between planned relaparotomy and laparostomy), which is explained by the lack of clear indications and convincing evidence of the benefits of any of those. The aim of the study was the development of a system of objective criteria for choosing an operative approach and an option for completing the operation in patients with generalized peritonitis. The work is based on the analysis of the results of treatment of 686 patients with the final diagnosis of generalized peritonitis. Abdominal sepsis at admission was diagnosed in 44 patients (6.4 %). In 302 (44.0 %) patients, a full surgical intervention was performed with laparoscopy. Initially, median laparotomy was performed in 205 patients (29.9 %). The closed method of completing laparotomy was used in 345 patients (77, 22.3 % died), staged planned operations — in 28 patients (18, 64.3 % died), and the open abdomen technique was used in 11 patients (5, 45.5 % died). The overall mortality was 15.0 % (103 patients died). Results. A system that, to a large extent, allows making a decision on the approach and completion of the operation in patients with generalized peritonitis has been created. The system was called the Index of Approach and Completion of Surgery for Secondary Peritonitis. The development of integral systems for assessing the severity of patient condition and choosing treatment tactics helps in systematizing the results, evaluating treatment results, and conducting scientific research.