Open management of the abdomen and planned reoperations in severe bacterial peritonitis.

Abstract

Objective: To assess the results of open management of the abdomen and planned re-operations in severe bacterial peritonitis after perforation or anastomotic disruption of the digestive tract.

Design: Retrospective study.

Setting: University Hospital, The Netherlands.

Subjects: 67 consecutive patients.

Interventions: Open management of the abdomen and planned reoperations.

Main outcome measures: Hospital morbidity and mortality, long-term follow-up.

Results: 38 patients developed multiple organ failure (MOF), but 29 needed only ventilatory and inotropic support. The mean number of re-operations was nine. 16 patients developed severe bleeding and 16 fistulas. In-hospital mortality was 42% (n = 28). Long-term morbidity, particularly the number of abdominal wall defects (n = 10), was considerable.

Conclusion: Despite open management of the abdomen and planned re-operations, mortality of severe bacterial peritonitis still continues to be too high, and both short and long-term morbidity are appreciable. The value of open management of the abdomen and planned re-operations rests only on the clinical observation that other conventional surgical treatments of severe bacterial peritonitis often fail.