Open versus Closed Management of the Abdomen in the Surgical Treatment of Severe Secondary Peritonitis: A Randomized Clinical Trial

Robledo, Felipe; Luque-de-León, Enrique; Suarez, Roberto Israel Caero; Sánchez, P. Cascales; de-la-Fuente, Mauricio; Vargas, Adriana; Mier, Juan

doi:10.1089/sur.2006.8.016

Cited by 100 publications

(83 citation statements)

References 32 publications

(40 reference statements)

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“…But desire of achieving this goal with a single operation, is not always possible. 15 In 1909 Notzel conceptualized peritoneal lavage and adequate intervention known as "source control" but mortality rate remained up to 60-90%. 16 Kirschner in 1926 presented an impressive study of 5468 patients and introduced basic principles of surgery in intra-abdominal infections: (i) elimination of the septic foci, (ii) removal of necrotic tissue, and (iii) drainage of purulent material that brought mortality to 50%.…”

Section: Discussionmentioning

confidence: 99%

Primary peritoneal drainage in critically ill patients of perforation peritonitis (an experience of 60 cases)

Bhasin¹,

Sharma²,

Azad³

2017

Int Surg J

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Background: Objective of the present study was to evaluate applicability of Primary Peritoneal Drainage (PPD) under LA in critically ill patients as pre-laparotomy support when laparotomy under GA could not be done. Also to assess outcome in terms of survival, patients needing definitive surgery and complications associated with the procedure on immediate and follow up basis.Methods: A prospective designed study including 60 critically ill patients admitted and diagnosed as perforation peritonitis were subjected to PPD under LA as per inclusion and exclusion criteria, at GMC Jammu, Jammu and Kashmir, India from November 2013 to October 2015.Results: The average age of patients was 53.43 years (20-80 years) with M:F ration of 7:3. All patients presented in shock with very high ASA, combined and MPI scores. 40 patients died after PPD/laparotomy and 20 patients survived. From amongst survivors, 08 (40%) patients required no further treatment and 12 (60%) survivors required definitive laparotomy and treatment of the cause. Overall mortality was 66.67%, attributed to extraordinary delay in presentation, old age, High ASA and other score.Conclusions: From the present study it was concluded that in adults the procedure did not proved comparable to standard surgical intervention as definite procedure but it did proved to be an effective modality of resuscitation and patient stabilization unlike in NEC of infants; PPD under LA. Overall the procedure is a low cost intervention and provide cheaper alternative to sustain and improvise the status of patient with a possibility of widespread applicability in low resource situations provided interdepartmental support from ICU, Dialysis and CCU is available.

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Section: Discussionmentioning

confidence: 99%

Primary peritoneal drainage in critically ill patients of perforation peritonitis (an experience of 60 cases)

Bhasin¹,

Sharma²,

Azad³

2017

Int Surg J

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“…They include elimination of the septic focus, removal of necrotic tissue, and drainage of purulent material [1] . Despite advances in antibiotics therapy and intensive care support, mortality and morbidity remain high [2] .…”

Section: Introductionmentioning

confidence: 99%

“…Despite advances in antibiotics therapy and intensive care support, mortality and morbidity remain high [2] . In certain cases of severe peritonitis, the surgeon may feel that a further look is required to achieve these goals [1] . This can be achieved by leaving the abdomen open at the index operation [3] .…”

Section: Introductionmentioning

confidence: 99%

Topical negative pressure in managing severe peritonitis: A positive contribution?

Amin¹,

Shaikh²

2009

WJG

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“…Even if little evidence exists, damage control surgery is employed in a wide range of abdominal emergencies and may be an increasingly recognized life-saving strategy in emergency surgery performed on physiologically deranged patients [119]. However, the role of the OA in the management of severe peritonitis is still being debated [120]. Robledo et al.…”

Section: Statement 15mentioning

confidence: 99%

Management of Intra-Abdominal Infections

Moore

2016

Common Problems in Acute Care Surgery

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This paper reports on the consensus conference on the management of intra-abdominal infections (IAIs) which was held on July 23, 2016, in Dublin, Ireland, as a part of the annual World Society of Emergency Surgery (WSES) meeting. This document covers all aspects of the management of IAIs. The Grading of Recommendations Assessment, Development and Evaluation recommendation is used, and this document represents the executive summary of the consensus conference findings.

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Open versus Closed Management of the Abdomen in the Surgical Treatment of Severe Secondary Peritonitis: A Randomized Clinical Trial

Abstract: This randomized study from a single institution demonstrates that closed management of the abdomen may be a more rational approach after operative treatment of SSP and questions the recent enthusiasm for the open alternative, which has been based on observational studies.

Cited by 100 publications

References 32 publications

Primary peritoneal drainage in critically ill patients of perforation peritonitis (an experience of 60 cases)

Primary peritoneal drainage in critically ill patients of perforation peritonitis (an experience of 60 cases)

Topical negative pressure in managing severe peritonitis: A positive contribution?

Management of Intra-Abdominal Infections

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