Peritoneum Viscera-Parietal Adhesive Disease and Laparotomy Wound Healing for Peritonitis

Бенсман, В. М.; Savchenko, Yu. P.; Sahakyan, E.A.; Малышко, В. В.

doi:10.20333/2500136-2019-5-72-79

Cited by 2 publications

(2 citation statements)

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“…Moreover, even in developed countries, the number of patients with peritonitis does not tend to decline, and their mortality rates remain high [31]. Mortality in diffuse peritonitis varies from 26 to 60%, reaching a level of 90-93% with the development of abdominal sepsis and toxic shock syndrome [32,33].…”

Section: Discussionmentioning

confidence: 99%

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New System For Predicting The Outcome Of Secondary Peritonitis

et al. 2021

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Despite improvements in the methods of diagnostics, surgical interventions and intensive care, the problem of treating patients with diffuse peritonitis remains relevant. Diffuse peritonitis is a major contributor to mortality in all urgent care settings and the second leading cause of sepsis in critically ill patients. At the same time, even in developed countries, the number of patients with peritonitis does not tend to decrease, and mortality rates remain high, reaching 90-93% with the development of abdominal sepsis and toxic shock syndrome. One of the ways to reduce mortality in peritonitis is the use of objective systems for prognosis of the peritonitis outcome, allowing to compare the results of patient treatment and to choose the optimal treatment tactics for each particular patient. The objective — To develop a new system for predicting the outcome of secondary peritonitis (survival or death) focused on the criteria of abdominal sepsis and multiple organ dysfunction syndrome (associated or not associated with peritonitis), and to analyze its accuracy versus the most common comparable systems. Material and Methods — Our study was based on analyzing the treatment outcomes in 352 patients with secondary diffuse peritonitis. On admission, sepsis was diagnosed in 15 (4.3%), and toxic shock in 4 (1.1%) patients. The main causes of death were purulent intoxication and/or sepsis (51 cases or 87.9%), cancer intoxication (4 cases or 6.9%), and acute cardiac failure (3 cases or 5.2%). We analyzed the effectiveness of several systems of predicting the peritonitis outcomes: the Mannheim’s Peritoneal Index (MPI), World Society for Emergency Surgery Sepsis Severity Score (WSES SSS), Acute Physiology and Chronic Health Evaluation II (APACHE II) system, general Sequential Organ Failure Assessment Score (gSOFA), as well as the Peritonitis Prognosis System (PPS) developed by the authors. The probability of the effect of 40 clinical and laboratory parameters on the outcome of patients with secondary peritonitis was analyzed via using parametric and nonparametric methods of statistical analysis (Fisher’s test, Mann-Whitney U test, Chi-squared test with Yates’s continuity correction). The criteria were selected that had a predictive power for the lethal outcome (p <0.05), and they were included in the PPS system. To compare the predictive value of the PPS, ROC analysis was conducted with construction of receiver operating characteristic curves for each analyzed system of predicting the peritonitis outcome. The STATISTICA 8 software was used for performing the statistical analysis. Results — The following criteria were of greatest importance in predicting the lethal outcome: a patient’s age, a presence of a malignant neoplasm, a nature of the exudate, the development of sepsis (toxic shock), as well as multiple organ dysfunction not associated with the developed peritonitis. PPS exhibited the greatest accuracy in terms of predicting mortality in patients with secondary diffuse peritonitis (AUC=0.942) versus minimal in APACHE II (AUC=0.840). Conclusion — APACHE II, MPI, WSES SSS and PPS can be considered reliable in terms of mortality prognosis in peritonitis patients. PPS has the greatest accuracy of predicting the mortality in patients with secondary diffuse peritonitis (94%).

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Section: Discussionmentioning

confidence: 99%

“…One of the leading risk factors for peritonitis is preoperative sepsis with associated organ dysfunctions and toxic shock [34]. Other factors include a patient's adaptive characteristics, concomitant diseases, especially those entailing organ failure, immunosuppression, and anatomical disorders associated with the disease [22,33].…”

Section: Discussionmentioning

confidence: 99%

New System For Predicting The Outcome Of Secondary Peritonitis

et al. 2021

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Analysis of the Outcomes of a New Method for Plastic Surgery for Postoperative Wound Of Sacrococcygeal Region after Excision of the Pilonidal Cyst: Randomized Trial.

Shubrov

Барышев

Triandafilov³

et al. 2022

Kuban. nauсh. med. vestnik

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Background. Despite a variety of existing methods of surgical treatment for sacrococcygeal pilonidal cyst, a universal technique has not been developed yet, due to the large number of postoperative complications and recurrences.Objectives. To improve the treatment outcomes of patients with pilonidal cysts through developing and implementing a new method for closure of the postoperative wound defect of the sacrococcygeal region.Methods. We conducted a randomized trial, involving 60 patients with sacrococcygeal pilonidal cyst. The control and main groups consisted of 30 people each. The study was carried out in the Purulent Surgery Unit of the Regional Clinical Hospital No. 1 — Research Institute, Krasnodar. The inclusion of patients in the trial was organized within 2019–2022 period. The duration of each patient’s follow-up period was equal to the hospitalization duration. The control group underwent the surgical treatment in the Moszkowicz (Moshkovich) modifi cation. The main group was treated by means of our own developed method. Postoperative wound complications were assessed according to Clavien—Dindo classifi cation. Statistical data processing was performed using Microsoft Excel 2013 with the add-ins Analysis package and AtteStat for statistical data.Results. The control and main groups included 30 participants each. The gender, age and body mass index (BMI) were not defi ned as statistically signifi cant. When analyzing the primary data, the treatment median time accounted for 10.5 (9.0; 13.8) days in the control group and 7.0 (7.0; 8.0) days in the main group, a signifi cant difference according to the Mann—Whitney test (p < 0.001). The number of postoperative complications (suture failure, wound abscess, necrosis of skin fl aps) in the control group was 16 cases, and in the main group — 1 case (signifi cance of differences under the chi-squared test p < 0.001). The number of recurrences in the control group comprised 7 cases, while in the main group there was 1 case (signifi cance of differences under the chi-squared test p = 0.023).Conclusion. The application of surgical treatment for pilonidal cysts in the authors’ modifi cation made it possible to reduce the time of hospitalization, the number of such postoperative complications as suture failure, wound abscess and necrosis of skin fl aps. The number of recurrences has also decreased significantly.

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Peritoneum Viscera-Parietal Adhesive Disease and Laparotomy Wound Healing for Peritonitis

Cited by 2 publications

References 0 publications

New System For Predicting The Outcome Of Secondary Peritonitis

New System For Predicting The Outcome Of Secondary Peritonitis

Analysis of the Outcomes of a New Method for Plastic Surgery for Postoperative Wound Of Sacrococcygeal Region after Excision of the Pilonidal Cyst: Randomized Trial.

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