Staged lavage versus single high-volume lavage in the treatment of feculent/purulent peritonitis: a matched pair analysis

Moussavian, M. R.; Richter, Sven; Kollmar, Otto; Schuld, Jochen; Schilling, Martin K.

doi:10.1007/s00423-008-0444-x

Cited by 12 publications

(10 citation statements)

References 22 publications

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“…We have shown that the use of larger volumes of intraoperative peritoneal irrigation offered no mortality benefit, regardless of the mechanism of injury, or the presence or severity of abdominal contamination as determined by the operating surgeon. This confirms similar findings in other populations (as stated above), and is a significant departure from the original evidence for its use at the beginning of the previous century [3][4][5][21][22][23][24]. The reason for this discrepancy is unclear, factor possibly involved include the use of antibiotics, improvements in surgical technique and the advent of critical care units.…”

Section: Discussionsupporting

confidence: 85%

“…It has since become part of the algorithm for any laparotomy, including the operative management of abdominal trauma. Multiple case reports and contemporary experts' opinions have been lodged in the biomedical literature over the course of the subsequent century, with subsequent variable and sometimes conflicting recommendations [3,5,9,24]. All however share (with little more than anecdotal evidence to support those claims) the same purported benefit: decreased bioburden on the peritoneal surface, by either mechanical removal of bacteria and other soilings or supposed bacteriolytic properties of the effluent, to prevent intrabdominal abscess formation.…”

Section: Discussionmentioning

confidence: 99%

“…One of these maneuvers is the use intraoperative irrigation. As some trauma patients present with ongoing peritonitis from bowel injury they will require control of the source of contamination, since intestinal perforation and soiling of the peritoneal cavity is associated with high morbidity and mortality [3]. The use of irrigation for washout after the conclusion of an emergency abdominal procedure in a trauma patient is a logical, ubiquitous maneuver taught and practiced for over one hundred years, and considered to meet the standard of care; especially in the setting of abdominal contamination with enteral contents.…”

Section: Introductionmentioning

confidence: 99%

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A Randomized Controlled Trial on Intra-Abdominal Irrigation during Emergency Trauma Laparotomy; Time for Yet Another Paradigm Shift

Mashbari

Hemdi

Chow

et al. 2018

BEAT

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Objective: To determine the optimal volume of abdominal irrigation that will prevent surgical site infections (both deep and superficial), eviscerations and fistula formations; and improve 30-day mortality in trauma patients. Methods:We conducted a three-arm parallel clinical superiority randomized controlled trial comparing different volumes of effluent (5, 10 and 20 liters) used in trauma patients (both blunt and penetrating) age 14 and above undergoing an emergency laparotomy between April 2002 and July 2004 in a busy urban Level 1 trauma center. Results: After randomization, a total of 204 patients were analyzed. All patient groups were comparable with respect to age, gender distribution, admission injury severity score, and mechanism of injury, estimated blood loss and degree of contamination. The mortality rate overall was 1.96% (4/204).No differences were noted with respect to contamination, wound infection, fistula formation, and evisceration. The twenty liter group (Group III) showed a trend toward an increased incidence of deep surgical site infections when compared to the five liter (Group I) (p=0.051) and ten liter (Group II) (p=0.057) groups. This did not however reach statistical significance. Conclusion: The old surgical adage "the solution to pollution is dilution" is not applicable to trauma patients. Our results suggest that using more irrigation, even when large amounts of contamination have occurred, does not reduce post-operative complications or affect mortality; and it may predispose patients to increased incidence of abscess formation. (Trial registration number: ISRCTN66454589)

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Randomized Controlled Trial on Intra-Abdominal Irrigation during Emergency Trauma Laparotomy; Time for Yet Another Paradigm Shift

Mashbari

Hemdi

Chow

et al. 2018

BEAT

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“…In addition, the OA treatment with NPWT represents a single arm study without any control group, so there is no way to determine if the rate of fistula would have been different with another treatment. Furthermore in one of both clinics including the majority of patients, single high volume lavage with primary closure of the fascia was preferred in the treatment of secondary peritonitis as published by our group in 2009 [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Negative Pressure Wound Therapy for the Treatment of the Open Abdomen and Incidence of Enteral Fistulas: A Retrospective Bicentre Analysis

Richter¹,

Dold

Doberauer

et al. 2013

Gastroenterology Research and Practice

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Introduction. The open abdomen (OA) is often associated with complications. It has been hypothesized that negative pressure wound therapy (NPWT) in the treatment of OA may provoke enteral fistulas. Therefore, we analyzed patients with OA and NPWT with special regard to the occurrence of intestinal fistulas. Methods. The present study included all consecutive patients with OA treated with NWPT from April 2010 to August 2011 in two hospitals. Patients' demographics, indications for OA, risk factors, complications, outcome and incidence of fistulas before, during and after NPWT were recorded. Results. Of 81 patients with OA, 26 had pre-existing fistulas and 55 were free from a fistula at the beginning of NPWT. Nine of the 55 patients developed fistulas during (n = 5) or after NPWT (n = 4). Seventy-five patients received ABThera therapy, 6 patients other temporary abdominal closure devices. Only diverticulitis seemed to be a significant predisposing factor for fistulas. Mortality was slightly lower for patients without fistulas. Conclusion. The present study revealed no correlation between occurrence of fistulas before, during, and after NWPT, with diverticulitis being the only risk factor. Fistula formation during NPWT was comparable to reports from literature. Prospective studies are mandatory to clarify the impact of NPWT on fistula formation.

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“…des Eingriffs empfiehlt sich eine Lavage des Abdomens, da hierdurch eine signifikante Verringerung der Keimzahl erreicht wird [1]. Der vorliegende Fall zeigt ein mögliches therapeutisches Vorgehen bei Patienten mit Koinzidenz von infrarenalem Bauchaortenaneurysma und Kolonkarzinom.…”

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Koinzidenz von symptomatischem infrarenalen Bauchaortenaneurysma und hämorrhagischem Ileozökaltumor

et al. 2010

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Einleitung ! Sperling J et al. Koinzidenz von symptomatischem infrarenalen Bauchaortenaneurysma … Zentralbl Chir 2010; 135: 354-357 Heruntergeladen von: WEST VIRGINIA UNIVERSITY. Urheberrechtlich geschützt. Kasuistik 355 Sperling J et al. Koinzidenz von symptomatischem infrarenalen Bauchaortenaneurysma … Zentralbl Chir 2010; 135: 354-357 Heruntergeladen von: WEST VIRGINIA UNIVERSITY. Urheberrechtlich geschützt.

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Staged lavage versus single high-volume lavage in the treatment of feculent/purulent peritonitis: a matched pair analysis

Cited by 12 publications

References 22 publications

A Randomized Controlled Trial on Intra-Abdominal Irrigation during Emergency Trauma Laparotomy; Time for Yet Another Paradigm Shift

A Randomized Controlled Trial on Intra-Abdominal Irrigation during Emergency Trauma Laparotomy; Time for Yet Another Paradigm Shift

Negative Pressure Wound Therapy for the Treatment of the Open Abdomen and Incidence of Enteral Fistulas: A Retrospective Bicentre Analysis

Koinzidenz von symptomatischem infrarenalen Bauchaortenaneurysma und hämorrhagischem Ileozökaltumor

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