Etappenlavage is defined as a series of planned multiple operative procedures performed at a 24-hour interval. It includes a commitment to reexplore the patient's abdomen at the initial corrective operation. This is a report of a prospective study of 117 patients treated by etappenlavage for severe advanced suppurative peritonitis in 2 institutions. Etappenlavage was performed in 15% of all patients with operations for peritonitis. In these patients, the abdominal infection had progressed to an advanced stage of severe functional impairment. A total of 669 laparotomies were performed and the abdomen closed temporarily utilizing retention sutures (n = 45), a simple zipper (n = 26), a slide fastener (n = 29), and Velcro analogue (n = 17). An average of 6.1 procedures were necessary to control the infection. In 57% of the patients, additional complications were recognized and repaired after the initial operation. Patients were artificially ventilated for an average of 17 days. The median duration of therapy was 33 (range, 3-183) days. Twenty-eight patients died between days 3 and 71 (median, 9) after initiation of therapy. In 88%, uncomplicated wound healing was observed after wounds were closed definitely. In the last 17 patients, no complications were attributable to the use of 2 adhesive sheets of polyamide plus nylon or perlon for temporary abdomimal closure (Velcro-like artificial burr). APACHE II scoring predicted a median mortality of 47%. The actual mortality was 25%. Overall, the mortality of advanced diffuse peritonitis was reduced from a predicted 34-93% (APACHE II/SIS scoring) to 24%. Velcro analogue (artificial burr) was the most practical device for temporary abdominal closure.

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Factors associated with a poor outcome following renovascular injuries include blunt trauma, the presence of a grade V injury, and an attempted arterial repair. Patients with blunt major vascular injuries (grade V) are likely to have associated major parenchymal disruption, which contributes to the poor function of the revascularized kidney. These patients may be best served by immediate nephrectomy, provided that there is a functioning contralateral kidney.