Management of postoperative peritonitis after anterior resection

Parc, Yann; Frileux, P; Schmitt, Ghislain; Dehni, Nidal; Ollivier, Jean; Parc, R

doi:10.1007/bf02235565

Cited by 63 publications

(64 citation statements)

References 24 publications

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“…Anastomotic insufficiency and postoperative ileus due to abdominal adhesions represent major complications following intestinal surgery, conditions associated with substantial morbidity and mortality 11 . We have previously shown that the combination of poly-L-lysine and poly-L-glutamate significantly reduces adhesions in an experimental model on abdominal adhesions 12 .…”

Section: Discussionmentioning

confidence: 99%

Increasing anastomosis safety and preventing abdominal adhesion formation by the use of polypeptides in the rat

Tingstedt

Nehéz

Axelsson

et al. 2005

Int J Colorectal Dis

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Methods: An ileocolic anastomosis was performed under both "clean" and "septic"conditions in the rat. The treatment group received intraperitoneal poly-L-lysine and poly-Lglutamate while controls received sodium chloride. Abdominal adhesions, anastomosis leakage and burst pressure were analyzed after 1, 3, 5 and 7 days in the "clean" anastomosis model and after 7 days in the "septic" model.Results: A significant decrease (p<0.01) in the amount of adhesions was seen in animals treated with polypeptides after 1, 3, and 5 days, while no difference was seen after 7 days.The anastomosis demonstrated a significantly higher burst pressure as evaluated day 1 and 3 (p<0.05 and p<0.01, respectively) in the polypeptide treated animals while no difference was seen between the groups at days 5 or 7.Conclusion: The use of differently charged polypeptides administered intraperitoneal after surgery resulted in a significant decrease in the extent of postoperative adhesions.Furthermore, an increase in intestinal anastomosis safety, based on improved burst pressure during the first 3 days, i.e. the critical period during the healing process, was noted. No adverse effects were seen in surgery during "septic" conditions.

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Section: Discussionmentioning

confidence: 99%

Increasing anastomosis safety and preventing abdominal adhesion formation by the use of polypeptides in the rat

Tingstedt

Nehéz

Axelsson

et al. 2005

Int J Colorectal Dis

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“…Niska przednia resekcja odbytnicy, wykonywana również za pomocą staplerów, jest najlepszą metodą leczniczą w raku środ-kowej i dystalnej części odbytnicy. Przetoka w wykonanym zespoleniu jest najczęstszym i niebezpiecznym powikłaniem, może wystąpić w 3-15% zabiegów [12,14]. Obraz kliniczny jest dość niejednolity -od niewielkich miejscowych objawów z radiologicznym potwierdzeniem ograniczonego przecieku do gwałtownie narastającej sepsy w przebiegu ropnia czy ropni w jamie brzusznej lub objawów zapalenia otrzewnej.…”

Section: Epidemiologiaunclassified

“…Obraz kliniczny jest dość niejednolity -od niewielkich miejscowych objawów z radiologicznym potwierdzeniem ograniczonego przecieku do gwałtownie narastającej sepsy w przebiegu ropnia czy ropni w jamie brzusznej lub objawów zapalenia otrzewnej. Śmiertelność w przypadkach przetoki z objawami zapalenia otrzewnej jest duża, sięga nawet 50% [12][13][14]. Sytuacja taka wymaga doraźnych zabiegów ratujących życie pacjenta.…”

Section: Epidemiologiaunclassified

“…Kontrast można podawać zarówno do jelita (odbytnica, stomia), jak i przez dren do jamy brzusznej. Określenie wielkości i miejsca przetoki może wpłynąć na decyzję odnośnie do sposobu leczenia nieszczelności zespolenia -zachowawczego lub operacyjnego [12][13][14].…”

Section: Diagnostykaunclassified

“…W trakcie operacji należy dokładnie rozpoznać oraz ocenić źródło zakażenia i jeśli jest to możliwe, przy pierwotnym zabiegu usunąć je wraz z zagrożoną częścią pienia przetoki, jednak statystycznie powikłanie to występuje u około 5% leczonych, a nawet częściej, bo u średnio 10% w przypadku niskiej przedniej resekcji [12,14]. Postępowanie lecznicze zależy od miejsca przetoki, objawów (miejscowe, ogólne) oraz wielkości przetoki.…”

Section: Leczenie Zasadniczeunclassified

See 2 more Smart Citations

Perforations in the colon

Ćwik¹,

Solecki²,

Ciechański³

et al. 2012

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Treatment of Postoperative Peritonitis of Small-Bowel Origin With Continuous Enteral Nutrition and Succus Entericus Reinfusion

Calicis

Parc²,

Caplin³

et al. 2002

Arch Surg

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Hypothesis: Proximal intestinal stomas established by the exteriorization of leaking anastomosis in the presence of peritonitis can be used to reinfuse succus entericus and provide adequate enteral nutrition. Design: Retrospective analysis of prospectively gathered data from a cohort of consecutive patients admitted between January 1993 and December 1999 for postoperative peritonitis requiring laparotomy and the construction of one or more small-bowel stomas. Setting: Tertiary referral center with a surgical intensive care unit experienced in the treatment of intraabdominal sepsis and succus entericus reinfusion. Patients: Twenty-one consecutive patients with postoperative peritonitis originating from a jejunal or ileal leak. We excluded patients with established enterocutaneous fistulae, abscesses amenable to percutaneous drainage or other conservative treatments, and postoperative peritonitis caused by ileocolic or ileorectal anastomosis. Interventions: Early laparotomy with exteriorization of small-bowel leak(s), and continuous enteral nutrition (CEN) and succus entericus reinfusion (SER) via the distal portion of the stoma until gastrointestinal continuity was restored. Main Outcome Measures: Feasibility of CEN and SER with temporary, diverting small-bowel stomas and their associated postoperative morbidity and mortality rates. Results: One patient died, and 14 experienced complications. For technical reasons, CEN and SER were discontinued early on in 7 patients. The mean duration of CEN and SER was 58 days and 61 days, respectively. Enteral feedings allowed the suppression of central venous access after a median of 28 days, with 82 days as a median time to restoration of intestinal continuity. Conclusions: Although the exteriorization of smallbowel leaks with CEN and SER is generally feasible and effective in the treatment of critically ill patients with peritonitis secondary to small-bowel leaks, it is associated with significant morbidity and mortality, in part relating to patients' underlying diseases.

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Management of postoperative peritonitis after anterior resection

Cited by 63 publications

References 24 publications

Increasing anastomosis safety and preventing abdominal adhesion formation by the use of polypeptides in the rat

Increasing anastomosis safety and preventing abdominal adhesion formation by the use of polypeptides in the rat

Perforations in the colon

Treatment of Postoperative Peritonitis of Small-Bowel Origin With Continuous Enteral Nutrition and Succus Entericus Reinfusion

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