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World Journal of Surgery Jul 2020Secondary peritonitis is associated with high rates of morbidity and mortality. Data on the effect of staged re-laparotomy or re-laparoscopy as a surgical option in the...
BACKGROUND
Secondary peritonitis is associated with high rates of morbidity and mortality. Data on the effect of staged re-laparotomy or re-laparoscopy as a surgical option in the management of abdominal sepsis due to secondary peritonitis are limited and conflicting. Herein, we report the outcomes of patients undergoing staged peritoneal lavage (SPL) for secondary peritonitis in our department.
METHODS
This is a single-center retrospective analysis of the data of patients undergoing SPL for secondary peritonitis. SPL was performed via either re-laparotomy or re-laparoscopy. The simplified acute physiology score (SAPS II) was calculated at the time of the initial operation and for each SPL. The end points of interest included: the evolution of sepsis characterized by the SAPS II score, the mortality rate and the rate of definitive abdominal wall closure.
RESULTS
The data of 74 patients with a median age of 73 years requiring at least one SPL between 2012 and 2019 were analyzed. The median number of SPL performed was three (range 1-12). A sequential drop of SAPS II score from 41 at the initial procedure to 32 at the third SPL was documented. The overall mortality rate was 16.2%, definitive abdominal closure was achieved in all surviving patients and the median length of stay was 17.5d CONCLUSION: Staged re-laparotomy or re-laparoscopy with peritoneal lavage may reduce the severity of peritonitis and reduce the risk of mortality in patients with abdominal sepsis. Maintaining the abdominal wall under constant retraction using a rigid mesh while creating an open abdomen is a crucial step in achieving definite abdominal wall closure. Thus, staged peritoneal lavage may be a good surgical option for selected patients with peritonitis.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Laparoscopy; Laparotomy; Male; Middle Aged; Peritoneal Lavage; Peritonitis; Retrospective Studies; Young Adult
PubMed: 32144471
DOI: 10.1007/s00268-020-05455-9 -
The New Zealand Medical Journal Feb 2020
Topics: Aged; Appendectomy; Empyema, Pleural; Female; Humans; Laparoscopy; Peritoneal Lavage; Postoperative Complications
PubMed: 32078605
DOI: No ID Found -
Pediatrics Nov 1949
Topics: Abdomen; Anuria; Child; Humans; Peritoneal Lavage; Urine
PubMed: 15391042
DOI: No ID Found -
Emergency Medicine Clinics of North... Feb 1993The management of the patient with blunt abdominal trauma remains in continuous flux. The emergency physician cannot place undue reliance on physical examination, and... (Review)
Review
The management of the patient with blunt abdominal trauma remains in continuous flux. The emergency physician cannot place undue reliance on physical examination, and plain radiography of the abdomen rarely adds to patient care. Laboratory tests, particularly elevated liver function tests or a large base deficit, may increase our suspicion for intraabdominal trauma. However, normal blood tests should never prevent further investigation as warranted by mechanism of injury or clinical picture. Ultrasound and laparoscopy are two diagnostic interventions that have been more extensively studied abroad than in the United States. With the advent of large clinical trials in our own country they should play a growing role in the diagnosis and management of abdominal trauma in the coming decade. DPL revolutionized the diagnosis of intraabdominal injury. It has an astoundingly impressive track record of 97% accuracy that is rivaled by few other tests in medicine. It has been criticized at times for being overly sensitive to trivial injuries, leading to nontherapeutic laparotomies. CT has the advantage of being relatively noninvasive and theoretically has the potential for decreasing nontherapeutic laparotomies, but is very reader-dependent and in many studies not as sensitive as peritoneal lavage. Both CT and DPL may miss critical intraabdominal injuries, but this is much less likely with lavage. Perhaps the greatest risk of CT is the delay it adds to performing a needed laparotomy. CT provides an excellent modality to screen for abdominal injury in the stable patient. However, the more critically injured a patient is, the greater the danger of delays introduced by CT. In these patients, greater emphasis should be placed on immediate DPL or direct transport to the operating room. The challenge in the 1990s will be to refine the diagnosis of intraabdominal trauma to allow for swift recognition of those injuries that require surgical intervention.
Topics: Abdominal Injuries; Ascitic Fluid; Blood Cell Count; Clinical Laboratory Techniques; Diagnostic Imaging; Humans; Laparoscopy; Laparotomy; Peritoneal Lavage; Physical Examination; Tomography, X-Ray Computed; Ultrasonography; Wounds, Nonpenetrating
PubMed: 8432243
DOI: No ID Found -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jan 2012Managing hemodynamically stable patients with thoracoabdominal stab wounds is still under dispute. This study aimed at discussing cut-off points of red blood cell (RBC)...
BACKGROUND
Managing hemodynamically stable patients with thoracoabdominal stab wounds is still under dispute. This study aimed at discussing cut-off points of red blood cell (RBC) count in diagnostic peritoneal lavage (DPL) effluent in these patients.
METHODS
Three hundred and eighty-eight patients with thoracoabdominal stab wounds and hemodynamically stable status were enrolled. In cases without a clear indication of laparotomy, the peritoneal cavity was washed out with 1000 ml of normal saline and the effluent fluid was analyzed for RBC count. RBC counts of >100,000/mm3 in abdominal wounds and of >10,000/mm3 in lower chest wounds were considered as indications for exploratory laparotomy (conventional approach). New cut-off points for RBC count were calculated in backward analysis.
RESULTS
Sensitivity and specificity of the conventional approach were 90% and 84%, respectively. RBC counts >15,000/mm3 in abdominal wounds and >25,000/mm3 in lower chest wounds were the best cut-off points in distinguishing patients with and without need of operation, with a sensitivity and specificity of 94% and 96%, respectively.
CONCLUSION
New cut-off points of RBC count in DPL effluent may promote management of patients with thoracoabdominal stab wounds and no obvious indication for operation.
Topics: Abdominal Injuries; Adolescent; Adult; Decision Trees; Emergency Service, Hospital; Female; Hemostasis; Humans; Laparoscopy; Male; Middle Aged; Peritoneal Lavage; Prospective Studies; Thoracic Injuries; Treatment Outcome; Turkey; Wounds, Penetrating; Young Adult
PubMed: 22290048
DOI: 10.5505/tjtes.2011.89137 -
New York State Journal of Medicine Oct 1987
Topics: Abdominal Injuries; Humans; Peritoneal Lavage; Tomography, X-Ray Computed
PubMed: 3479718
DOI: No ID Found -
European Journal of Surgical Oncology :... Apr 2024Diagnostic laparoscopy (DL) with peritoneal lavage has been adopted as a standard staging procedure for patients with gastric cancer (GC). Evaluation of the value of DL...
INTRODUCTION
Diagnostic laparoscopy (DL) with peritoneal lavage has been adopted as a standard staging procedure for patients with gastric cancer (GC). Evaluation of the value of DL is important given ongoing improvements in diagnostic imaging and treatment. As contemporary data from European centres are sparse, this retrospective cohort study aimed to assess the yield of DL in patients with potentially curable gastric cancer, and to identify predictive factors for peritoneal metastases.
METHODS
Patients with adenocarcinoma of the stomach, treated between January 2016 and December 2018, were identified from institutional databases of two high volume European Upper-GI centres. Patients who underwent a DL with peritoneal lavage for potentially curable disease after clinical staging with imaging (cT1-4N0-3M0) were included. The primary outcome was the proportion of patients with a positive DL, defined as macroscopic metastatic disease, positive peritoneal cytology washings (PC+) or locally irresectable disease.
RESULTS
Some 80 of 327 included patients (24.5%) had a positive DL, excluding these patients from neoadjuvant treatment (66 of 327; 20.2%) and/or surgical resection (76 of 327; 23.2%). In 34 of 327 patients (10.3%), macroscopic metastatic disease was seen, with peritoneal deposits in 30 of these patients. Only 16 of 30 patients with peritoneal disease had positive cytology. Some 41 of 327 patients (12.5%) that underwent DL had PC+ in the absence of macroscopic metastases and five patients (1.5%) had an irresectable primary tumour. Diffuse type carcinoma had the highest risk of peritoneal dissemination, irrespective of cT and cN categories.
CONCLUSION
The diagnostic yield of staging laparoscopy is high, changing the management in approximately one quarter of patients. DL should be considered in patients with diffuse type carcinoma irrespective of cT and cN categories.
Topics: Humans; Peritoneal Lavage; Stomach Neoplasms; Retrospective Studies; Peritoneal Neoplasms; Neoplasm Staging; Laparoscopy; Adenocarcinoma
PubMed: 38428107
DOI: 10.1016/j.ejso.2024.108233 -
Techniques in Coloproctology Jun 2015
Topics: Colectomy; Colon, Sigmoid; Contraindications; Diverticulum, Colon; Elective Surgical Procedures; Humans; Laparoscopy; Peritoneal Lavage; Peritonitis
PubMed: 25917857
DOI: 10.1007/s10151-015-1305-6 -
Critical Care (London, England) Feb 2013Mild therapeutic hypothermia (MTH) is a worldwide used therapy to improve neurological outcome in patients successfully resuscitated after cardiac arrest (CA).... (Observational Study)
Observational Study
INTRODUCTION
Mild therapeutic hypothermia (MTH) is a worldwide used therapy to improve neurological outcome in patients successfully resuscitated after cardiac arrest (CA). Preclinical data suggest that timing and speed of induction are related to reduction of secondary brain damage and improved outcome.
METHODS
Aiming at a rapid induction and stable maintenance phase, MTH induced via continuous peritoneal lavage (PL) using the Velomedix Inc. automated PL system was evaluated and compared to historical controls in which hypothermia was achieved using cooled saline intravenous infusions and cooled blankets.
RESULTS
In 16 PL patients, time to reach the core target temperature of 32.5°C was 30 minutes (interquartile range (IQR): 19 to 60), which was significantly faster compare to 150 minutes (IQR: 112 to 240) in controls. The median rate of cooling during the induction phase in the PL group of 4.1°C/h (IQR: 2.2 to 8.2) was significantly faster compared to 0.9°C/h (IQR: 0.5 to 1.3) in controls. During the 24-hour maintenance phase mean core temperature in the PL patients was 32.38 ± 0.18°C (range: 32.03 to 32.69°C) and in control patients 32.46 ± 0.48°C (range: 31.20 to 33.63°C), indicating more steady temperature control in the PL group compared to controls. Furthermore, the coefficient of variation (VC) for temperature during the maintenance phase was lower in the PL group (VC: 0.5%) compared to the control group (VC: 1.5%). In contrast to 23% of the control patients, none of the PL patients showed an overshoot of hypothermia below 31°C during the maintenance phase. Survival and neurological outcome was not different between the two groups. Neither shivering nor complications related to insertion or use of the PL method were observed.
CONCLUSIONS
Using PL in post-CA patients results in a rapidly reached target temperature and a very precise maintenance, unprecedented in clinical studies evaluating MTH techniques. This opens the way to investigate the effects on neurological outcome and survival of ultra-rapid cooling compared to standard cooling in controlled trials in various patient groups.
TRIAL REGISTRATION
ClinicalTrials.gov: NCT01016236
Topics: Aged; Female; Heart Arrest; Humans; Hypothermia, Induced; Male; Middle Aged; Patient Safety; Peritoneal Lavage; Prospective Studies; Resuscitation; Time Factors; Treatment Outcome
PubMed: 23425514
DOI: 10.1186/cc12518 -
Digestive Surgery 2015Contemporary surgical management of complicated diverticulitis is controversial. Traditionally, the gold standard has been resection and colostomy, but recently...
BACKGROUND
Contemporary surgical management of complicated diverticulitis is controversial. Traditionally, the gold standard has been resection and colostomy, but recently peritoneal lavage and drainage without resection in cases of purulent peritonitis have been suggested. This study aims to review our initial experience with laparoscopic peritoneal lavage for complicated diverticulitis.
METHODS
Retrospective review of all patients who underwent emergent peritoneal lavage and drainage for acute complicated diverticulitis.
RESULTS
Five-hundred-thirty-eight patients admitted for acute diverticulitis between 2007 and 2012 were recorded in the database. Thirty seven underwent emergent surgery of which 10 had peritoneal lavage and drainage without colonic resection for complicated diverticulitis causing peritonitis. Peritoneal lavage and drainage resulted in the resolution of acute symptoms in all cases. In long-term follow-up, 3 (30%) patients required elective resection owing to symptomatic disease, two of these due to recurrent diverticulitis, and one owing to complicated fistula following the procedure.
CONCLUSION
Peritoneal lavage is a feasible option for complicated diverticulitis with purulent non-fecal peritonitis, but a significant portion of the patients may require elective resection. Comparative studies with emergent resection are needed to determine the role of peritoneal lavage in complicated diverticulitis.
Topics: Acute Disease; Adult; Aged; Combined Modality Therapy; Diverticulitis, Colonic; Drainage; Female; Follow-Up Studies; Humans; Laparoscopy; Male; Middle Aged; Peritoneal Lavage; Peritonitis; Retrospective Studies; Treatment Outcome
PubMed: 25765997
DOI: 10.1159/000375539