Recent developments in the surgical management of complex intra-abdominal infection

Soop, Mattias; Carlson, Gordon L

doi:10.1002/bjs.10437

Cited by 23 publications

(15 citation statements)

References 44 publications

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“… 19 With the increase in availability of cross-sectional imaging and interventional radiology, advances have been made in the diagnosis and nonoperative control of abdominal and pelvic collections, and the vast majority of patients can be controlled without early open surgery. 20 …”

Section: Initial Management Of Intestinal Failurementioning

confidence: 99%

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Assessment and management of patients with intestinal failure: a multidisciplinary approach

Grainger¹,

Maeda²,

Donnelly³

et al. 2018

CEG

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Intestinal failure (IF) is a condition characterized by the inability to maintain a state of adequate nutrition, or fluid and electrolyte balance due to an anatomical or a physiological disorder of the gastrointestinal system. IF can be an extremely debilitating condition, significantly affecting the quality of life of those affected. The surgical management of patients with acute and chronic IF requires a specialist team who has the expertise in terms of technical challenges and decision-making. A dedicated IF unit will have the expertise in patient selection for surgery, investigative workup and planning, operative risk assessment with relevant anesthetic expertise, and a multidisciplinary team with support such as nutritional expertise and interventional radiology. This article covers the details of IF management, including the classification of IF, etiology, prevention of IF, and initial management of IF, focusing on sepsis treatment and nutritional support. It also covers the surgical aspects of IF such as intestinal reconstruction, abdominal wall reconstruction, and intestinal transplantation.

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Section: Initial Management Of Intestinal Failurementioning

confidence: 99%

“…Rapid commencement in these patients once sepsis is confirmed is needed as there is good evidence to show a strong relationship between the timeliness of therapy and survival. 20 …”

Section: Initial Management Of Intestinal Failurementioning

confidence: 99%

Assessment and management of patients with intestinal failure: a multidisciplinary approach

Grainger¹,

Maeda²,

Donnelly³

et al. 2018

CEG

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“…Acute peritonitis is associated with high rates of morbidity and mortality, and careful control of the source of infection remains key to a successful treatment [8,23]. e use of minimally invasive surgical techniques, in particular percutaneous fluid drainage and laparoscopy, has been exceptionally valuable in cases of complex abdominal infections in patients with borderline physiological conditions such as diabetes, obesity, advanced age, and immunosuppression, where the negative impact of a laparotomy, although fundamental for the control of infection, may outweigh the benefit [23]. Although percutaneous drainage is feasible in most cases, some complex situations, such as unapproachable anatomical site or abscesses between loops, fistulas, and ischemic areas, require resection and catheter drainage is not practical [23].…”

Section: Discussionmentioning

confidence: 99%

“…e use of minimally invasive surgical techniques, in particular percutaneous fluid drainage and laparoscopy, has been exceptionally valuable in cases of complex abdominal infections in patients with borderline physiological conditions such as diabetes, obesity, advanced age, and immunosuppression, where the negative impact of a laparotomy, although fundamental for the control of infection, may outweigh the benefit [23]. Although percutaneous drainage is feasible in most cases, some complex situations, such as unapproachable anatomical site or abscesses between loops, fistulas, and ischemic areas, require resection and catheter drainage is not practical [23]. For these reasons, laparoscopic procedures have gained popularity among surgeons for the performance of difficult operations on patients with abdominal sepsis [8].…”

Section: Discussionmentioning

confidence: 99%

Does Helium Pneumoperitoneum Reduce the Hyperinflammatory Response in Septic Animals during Laparoscopy?

Bicalho

Marçal

Alvarenga

et al. 2020

Surgery Research and Practice

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Background/Aim. An exacerbated reaction to peritoneal infection and attendant surgical procedures is characterized by an intense hyperinflammatory state, the magnitude of which is proportional to the severity of tissue injury. Laparoscopy generates lower levels of tissue damage compared with open surgery and should induce less pronounced immune responses. The aim of this study was to determine whether laparoscopy assisted by helium rather than carbon dioxide pneumoperitoneum would induce an attenuated inflammatory state in septic animals. Materials and Methods. Thirty-two Wistar rats were divided randomly into four equal groups, two of which were submitted to carbon dioxide or helium pneumoperitoneum-assisted laparoscopic cecal ligation and puncture (CLP) induced sepsis and subsequent abdominal lavage. Two control groups were submitted to identical laparoscopic procedures with carbon dioxide or helium as insufflator gas but without CLP. After 24 hours, serum levels of tumor necrosis factor alpha (TNF-α), interleukins 1 and 6 (IL-1 and IL-6, respectively), and cortisol were determined. Results. Mean concentrations of I L-1 and IL-6 in the groups of septic animals submitted to laparoscopy with carbon dioxide or helium pneumoperitoneum were not significantly different but were significantly higher than those of their respective non-CLP controls. In contrast, the levels of TNF-α and cortisol in the two groups of septic animals were similar but were not significantly different from those of their respective non-CLP controls. Conclusions. Laparoscopy with helium insufflation was similar to carbon dioxide in relation to the inflammatory response since levels of the proinflammatory TNF-α, IL-1, and IL-6 and of the anti-inflammatory cortisol were comparable for both gases.

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“…It is emphasized that abdominal sepsis is a result of both intraabdominal and retroperitoneal infections. [4][5] In a retrospective cohort study with patients diagnosed with sepsis and septic shock at a ICU in Rio Branco, Acre, it was identified that septic patients with a focus of abdominal infection presented the highest risk of death (HR: 3.71; 95% CI: 1.31-10.49) and 100% of these died at the end of 24 days of hospitalization. 6 In view of the problem, it is of paramount importance that health professionals are instrumented, aiming to collaborate, thus, in the care of the patient with sepsis of abdominal focus.…”

mentioning

confidence: 99%

Construção e validação de conteúdo de formulário para pacientes sépticos

Volpáti

Prado

Maggi

2019

Rev enferm UFPE on line.

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RESUMO Objetivo: construir um instrumento para a coleta de dados de pacientes com sepse de foco abdominal em Unidades de Terapia Intensiva (UTI). Método: trata-se de um estudo metodológico, de construção e validação de conteúdo, realizado em três etapas: revisão integrativa da literatura; construção do instrumento e validação de conteúdo do instrumento. Apresentaram-se os resultados em forma de figuras. Resultados: validou-se o instrumento por 23 juízes, sendo 18 (78,3%) enfermeiros e cinco (21,7%) médicos. Aponta-se que o instrumento resultou em 84 variáveis divididas em seis domínios. Constata-se que, após as contribuições, todos os avaliadores julgaram que os itens são suficientes. Conclusão: conclui-se que o instrumento construído é válido, segundo os especialistas, para a coleta de dados de forma sistematizada dos pacientes sépticos de foco abdominal em Unidades de Terapia Intensiva. Descritores: Estudos de Validação; Sepse; Abdome; Unidades de Terapia Intensiva; Coleta de Dados; Fatores de Risco.ABSTRACT Objective: to construct an instrument for the collection of data from patients with sepsis of abdominal focus in Intensive Care Units (ICU). Method: this is a methodological study, construction and validation of content, carried out in three stages: integrative literature review; instrument construction and validation of instrument content. The results were presented in the form of figures. Results: the instrument was validated by 23 judges, of which 18 (78.3%) were nurses and five (21.7%) were physicians. It is pointed out that the instrument resulted in 84 variables divided into six domains. It is noted that, after the contributions, all the evaluators judged that the items are sufficient. Conclusion: it is concluded that the instrument constructed is valid, according to experts, for systematic data collection of septic patients with abdominal focus in Intensive Care Units. Descriptors: Validation Studies; Sepsis; Abdomen; Intensive Care Units; Data collection; Risk factors.RESUMEN Objetivo: construir un instrumento para la recolección de datos de pacientes con sepsis de foco abdominal en Unidades de Terapia Intensiva (UTI). Método: se trata de un estudio metodológico, de construcción y validación de contenido, realizado en tres etapas: revisión integrativa de la literatura; construcción del instrumento y validación de contenido del instrumento. Se presentaron los resultados en forma de figuras. Resultados: se validó el instrumento por 23 jueces, siendo 18 (78,3%) enfermeros y cinco (21,7%) médicos. Se señala que el instrumento resultó en 84 variables divididas en seis dominios. Se constata que, después de las contribuciones, todos los evaluadores juzgaron que los ítems son suficientes. Conclusión: se concluye que el instrumento construido es válido, según los especialistas, para la recolección de datos de forma sistematizada de los pacientes sépticos de foco abdominal en Unidades de Terapia Intensiva. Descriptores: Estudios de Validación; sepsis; abdomen; Unidades de Terapia Intensiva; Recolección de datos; Factores de Riesgo.

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Recent developments in the surgical management of complex intra-abdominal infection

Cited by 23 publications

References 44 publications

Assessment and management of patients with intestinal failure: a multidisciplinary approach

Assessment and management of patients with intestinal failure: a multidisciplinary approach

Does Helium Pneumoperitoneum Reduce the Hyperinflammatory Response in Septic Animals during Laparoscopy?

Construção e validação de conteúdo de formulário para pacientes sépticos

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