Planned relaparotomies and open abdomen in severe secondary peritonitis

Abstract

Severe secondary peritonitis remains a highly lethal disease in surgical practice. Planned relaparotomies and open management of the abdomen have been introduced for intra-abdominal sepsis and variable results are reported. Between 1992 and 2004 the medical records of non-trauma patients who underwent planned relaparotomies and open abdomen for secondary peritonitis at our hospital were investigated. Patients are seperated in the groups depending on the source of intra-abdominal infection from upper or lower gastrointestinal system (GIS). Sixty-four laparotomies have been performed in 30 patients. Open management of the abdomen with wet laparotomy pads were the most common used technique. The most encountered complication was intestinal fistula. In-hospital mortality was 43,3%. The mortality rate was higher in patients who were operated for indications emerging from upper GIS conditions (p=0.05). Despite such aggressive therapies, mortality and morbidity in severe secondary peritonitis is still high. Further, prospective trials with large series of homogeneous patient groups are needed to define optimal techniques for open management of abdomen.