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Pancreas Mar 2019This study aimed to compare the efficacy of percutaneous drainage (PCD) versus peritoneal lavage (PL) for the treatment for severe acute pancreatitis patients with... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
This study aimed to compare the efficacy of percutaneous drainage (PCD) versus peritoneal lavage (PL) for the treatment for severe acute pancreatitis patients with pancreatic ascites (PAs).
METHODS
Severe acute pancreatitis patients with PAs were randomly assigned within 3 days of onset of symptoms to receive either PL or PCD. The primary end point was a composite of mortality or major complications during hospitalization and within 1 month of discharge. Per-protocol analyses were performed.
RESULTS
Between September 2011 and June 2014, 86 patients were randomly assigned to intervention with PL or PCD. Ultimately, 41 patients in the PCD group and 39 patients in the PL group completed the study. The primary end point occurred in 15 (36.6%) of 41 patients in the PCD group and in 17 (43.6%) of 39 patients in the PL group (risk ratio, 0.84; 95% confidence interval, 0.49-1.44; P = 0.27). Mortality or major complications did not differ between the groups. Percutaneous drainage reduced intra-abdominal hypertension; however, PL reduced the incidence of deep venous thrombosis and pancreatic encephalopathy and was associated with a reduced need for intervention.
CONCLUSIONS
In our study, the PCD was not superior to the PL in reducing mortality or major complications in severe acute pancreatitis patients with PAs.
Topics: Acute Disease; Adult; Ascites; Drainage; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pancreatic Diseases; Pancreatitis; Peritoneal Lavage; Prospective Studies; Severity of Illness Index; Survival Analysis
PubMed: 30789387
DOI: 10.1097/MPA.0000000000001251 -
Deutsche Krankenpflegezeitschrift Jun 1990
Topics: Humans; Pancreatitis; Peritoneal Lavage; Peritonitis
PubMed: 2115840
DOI: No ID Found -
European Journal of Emergency Medicine... Aug 2007It has been suggested that diagnostic peritoneal lavage is now obsolete in UK hospitals with access to either skilled ultrasonography or emergency physician or...
OBJECTIVE
It has been suggested that diagnostic peritoneal lavage is now obsolete in UK hospitals with access to either skilled ultrasonography or emergency physician or surgeon-performed focused abdominal sonography in trauma. Diagnostic peritoneal lavage continues to be advocated and taught on Advanced Trauma Life Support courses. The aim of this study was to evaluate the experiences and attitudes of general-surgery trainees in one UK training region towards diagnostic peritoneal lavage and focused abdominal sonography in trauma in managing blunt abdominal trauma.
METHODS
An anonymous postal piloted questionnaire was sent to all 66 general surgery specialist trainees in one UK training region between January and March 2005.
RESULTS
Out of 40 replies to the questionnaire (response rate 61%), 53% and 38% of surgical trainees had either never performed or never observed a diagnostic peritoneal lavage during their training. Thirteen trainees (33%) felt diagnostic peritoneal lavage to be obsolete and would never contemplate using it; 15 trainees (37%) might consider using diagnostic peritoneal lavage if computed tomography or ultrasonography were unavailable. Ten trainees (25%) felt that diagnostic peritoneal lavage had been superseded by computed tomography. Only 12 trainees (30%) had worked in a UK hospital with access to facilities for focused abdominal sonography in trauma and only seven trainees (18%) had received any training or experience in focused abdominal sonography in trauma.
CONCLUSIONS
Surgical trainees in one UK training region lack skills in both diagnostic peritoneal lavage and focused abdominal sonography in trauma for managing blunt abdominal trauma and are therefore reliant upon the availability of prompt, skilled radiological assistance or emergency physician-provided focused abdominal sonography in trauma.
Topics: Abdominal Injuries; Attitude of Health Personnel; General Surgery; Humans; Life Support Care; Peritoneal Lavage; Students, Medical; Surveys and Questionnaires; Ultrasonography; United Kingdom; Wounds, Nonpenetrating
PubMed: 17620912
DOI: 10.1097/MEJ.0b013e3280bef8ba -
The British Journal of Surgery Jan 2008The standard approach to generalized peritonitis due to perforated diverticulitis involves open surgery and diversion of faecal content. This study assessed the...
BACKGROUND
The standard approach to generalized peritonitis due to perforated diverticulitis involves open surgery and diversion of faecal content. This study assessed the feasibility of laparoscopic peritoneal lavage.
METHODS
A prospective multi-institutional study of 100 patients was undertaken. All consenting patients with perforated diverticulitis causing generalized peritonitis underwent attempted laparoscopic peritoneal lavage. The degree of peritonitis, according to the Hinchey grading system, was recorded. Primary endpoints were operative success and resolution of symptoms.
RESULTS
Patients had a median age of 62.5 (range 39-94) years, a male : female ratio of 2 : 1 and a median American Society of Anesthesiologists grade of III (range II-V). Eight patients with grade 4 diverticulitis had conversion to an open Hartmann's procedure. The remaining 92 patients were managed by laparoscopic lavage, with morbidity and mortality rates of 4 and 3 per cent respectively. Two patients required postoperative intervention for a pelvic abscess. Only two patients re-presented with diverticulitis at a median follow up of 36 (range 12-84) months.
CONCLUSION
Laparoscopic management of perforated diverticulitis with generalized peritonitis is feasible, with a low recurrence risk in the short term.
Topics: Adult; Aged; Aged, 80 and over; Diverticulitis, Colonic; Feasibility Studies; Female; Humans; Intestinal Perforation; Laparoscopy; Male; Middle Aged; Peritoneal Lavage; Peritonitis; Prospective Studies
PubMed: 18076019
DOI: 10.1002/bjs.6024 -
The International Journal of Artificial... Jan 2006The first peritoneal accesses were devices that had been used in other fields (general surgery, urology, or gynecology): trocars, rubber catheters, and sump drains. In... (Review)
Review
The first peritoneal accesses were devices that had been used in other fields (general surgery, urology, or gynecology): trocars, rubber catheters, and sump drains. In the period after World War II, numerous papers were published with various modifications of peritoneal dialysis. The majority of cases were treated with the continuous flow technique; rubber catheters for inflow and sump drains for outflow were commonly used. At the end of the 1940s, intermittent peritoneal dialysis started to be more frequently used. Severe complications of peritoneal accesses created incentive to design accesses specifically for peritoneal dialysis. The initial three, in the late 1940s, were modified sump drains; however, Ferris and Odel for the first time designed a soft, polyvinyl intraperitoneal tube with metal weights to keep the catheter tip in the pelvic gutter where the conditions for drain are the best. In the 1950s, intermittent peritoneal dialysis was established as the preferred technique; polyethylene and nylon catheters became commercially available and peritoneal dialysis was established as a valuable method for treatment of acute renal failure. The major breakthrough came in the 1960s. First of all, it was discovered that the silicone rubber was less irritating to the peritoneal membrane than other plastics. Then, it was found that polyester velour allowed an excellent tissue ingrowth creating a firm bond with the tissue. When a polyester cuff was glued to the catheter, it restricted catheter movement and created a closed tunnel between the integument and the peritoneal cavity. In 1968, Tenckhoff and Schechter combined these two features and designed a silicone rubber catheter with a polyester cuff for treatment of acute renal failure and two cuffs for treatment of chronic renal failure. This was the most important development in peritoneal access. Technological evolution never ends. Multiple attempts have been made to eliminate remaining complications of the Tenckhoff catheter such as exit/tunnel infection, external cuff extrusion, migration leading to obstruction, dialysate leaks, recurrent peritonitis, and infusion or pressure pain. New designs combined the best features of the previous ones or incorporated new elements. Not all attempts have been successful, but many have. To prevent catheter migration, Di Paolo and his colleagues applied the old idea of providing weights at the catheter tips to Tenckhoff catheters. In another modification, Twardowski and his collaborators created a permanent bend to the intra-tunnel portion of the silicone catheter to eliminate cuff extrusions. The Tenckhoff catheter continues to be widely used for chronic peritoneal dialysis, although its use is decreasing in favor of swan-neck catheters. Soft, silicone rubber instead of rigid tubing virtually eliminated such early complications as bowel perforation or massive bleeding. Other complications, such as obstruction, pericatheter leaks, and superficial cuff extrusions have been markedly reduced in recent years, particularly with the use of swan-neck catheters and insertion through the rectus muscle instead of the midline. However, these complications still occur, so new designs are being tried.
Topics: Animals; Catheterization; History, 20th Century; Humans; Peritoneal Dialysis; Peritoneal Lavage
PubMed: 16485237
DOI: 10.1177/039139880602900102 -
South African Journal of Surgery.... Mar 1989
Review
Topics: Antisepsis; Humans; Intraoperative Care; Peritoneal Lavage
PubMed: 2658137
DOI: No ID Found -
Acta Cirurgica Brasileira Jun 2017To establish and evaluate the feasibility of continuous peritoneal lavage with vacuum peritoneostomy in an animal model.
PURPOSE:
To establish and evaluate the feasibility of continuous peritoneal lavage with vacuum peritoneostomy in an animal model.
METHODS:
Eight pigs aged 3-4 months, females, were anesthetized and submitted to laparotomy and installation of a continuous peritoneal lavage with vacuum peritoneostomy. The sta-bility of the system, the physiological effects of washing with NaCl 0.9% and the sys-tem clearance were evaluated.
RESULTS:
Stability of vacuum peritoneostomy was observed, with no catheter leaks or obstructions and the clearance proved adequate, however, the mean volume of fluids aspirated by the peritoneostomy at the end of the experiment was higher than the volume infused by the catheters (p=0.02). Besides that, the animals presented a progressive increase in heart rate (p=0.04) and serum potassium (p=0.02).
CONCLUSION:
The continuous peritoneal lavage technique with vacuum peritoneostomy is feasible and presents adequate clearance.
Topics: Animals; Feasibility Studies; Female; Models, Animal; Peritoneal Lavage; Peritoneum; Swine
PubMed: 28700008
DOI: 10.1590/s0102-865020170060000007 -
Pathology Oncology Research : POR Apr 2020The main objective of this study was to investigate the incidence of free tumour cells in peritoneal lavage cytology performed using a standard method before and after...
The main objective of this study was to investigate the incidence of free tumour cells in peritoneal lavage cytology performed using a standard method before and after the resection of the tumour, and to assess the usefulness of this technique in scheduled interventions on colorectal cancer patients. Peritoneal lavage cytology was performed on a homogeneous sample of 188 patients undergoing colorectal cancer curative resection before and after the resection of the tumour. The procedure was performed systematically in all cases. Malignant cells were detected in the peritoneal lavage cytology performed before the resection of the tumour in three patients. Lymph node affection was the variable most associated with the prognosis of these colorectal cancer patients. Peritoneal lavage cytology can provide additional information for a small group of patients who need to be closely monitored and studied to decide on the most effective type of chemotherapy.
Topics: Adult; Aged; Aged, 80 and over; Colorectal Neoplasms; Cytodiagnosis; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Peritoneal Lavage
PubMed: 31401769
DOI: 10.1007/s12253-019-00706-0 -
Nihon Rinsho. Japanese Journal of... Nov 2004Peritoneal lavage was developed as a simple method to evacuate the ascitic fluid associated with pancreatitis. Although a number of studies demonstrated its efficacy in... (Review)
Review
Peritoneal lavage was developed as a simple method to evacuate the ascitic fluid associated with pancreatitis. Although a number of studies demonstrated its efficacy in improvement of clinical manifestations, a meta-analysis of randomized control studies could not reveal its effectiveness on mortality or morbidity in severe acute pancreatitis. However, it has been well established that the ascitic fluid with pancreatitis is extremely toxic and to induce organ damage due to apoptotic cell death. Particularly, we have recently found that the ascitic fluid with pancreatitis can induce bacterial translocation due to the increase of gut permeability. Therapeutic strategy of peritoneal lavage, i.e. evacuation of toxic substances from peritoneal cavity, should be reevaluated to achieve further improvement of treatment result of severe acute pancreatitis.
Topics: Acute Disease; Animals; Apoptosis; Ascitic Fluid; Bradykinin; DNA Fragmentation; Histamine; Humans; Pancreatitis; Peritoneal Lavage; Severity of Illness Index
PubMed: 15552893
DOI: No ID Found -
Journal of Gastroenterology and... Jun 2001It has been postulated that continuous irrigation of the peritoneal cavity with crystalloid solutions in patients with acute pancreatitis can improve mortality and... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIM
It has been postulated that continuous irrigation of the peritoneal cavity with crystalloid solutions in patients with acute pancreatitis can improve mortality and morbidity. The aim of the study is to perform a meta-analysis of available randomized prospective clinical trials, to evaluate whether lavage influences mortality and morbidity in patients with acute pancreatitis.
METHODS
We performed a computer search of Medline for all available literature on the use of lavage in patients with acute pancreatitis. A meta-analysis was conducted on eight randomized, prospective, clinical trials (a total of 333 patients) evaluating continuous peritoneal lavage in patients with acute pancreatitis. The end-points were mortality and morbidity (i.e. pancreatic necrosis, peripancreatic fluid collections, intra-abdominal abscess formation, septicemia, organ system failure).
RESULTS
Continuous lavage did not improve either mortality (weighted mean difference 1.6%, 95% CI -6.7% to 9.9%, not significant (n.s.)) or morbidity (weighted mean difference 6.2%, 95% CI -3.2% to 15.6%, n.s.) when compared with control patients.
CONCLUSIONS
The use of continuous peritoneal lavage in patients with acute pancreatitis has not been found to be associated with any significant improvement in mortality or morbidity.
Topics: Acute Disease; Humans; Pancreatitis; Peritoneal Lavage; Randomized Controlled Trials as Topic
PubMed: 11422624
DOI: 10.1046/j.1440-1746.2001.02497.x