Comparative Evaluation of Various Methods of Drainage of the Abdominal Cavity in Patients with Secondary Bacterial Peritonitis

Abstract

Background: Secondary peritonitis is a serious complication of all the inflammatory diseases and injuries of the abdominal organs and requires urgent surgical intervention. The mortality rate of patients with secondary bacterial peritonitis (SBP) reaches 70%. In some patients, despite the treatment, secondary peritonitis turns into tertiary peritonitis (TP), which complicates the healing process and aggravates the prognosis. Inadequate drainage of the abdominal cavity is a possible contributing factor to the formation of TP. Aims: A prospective study of the result of surgical treatment of patients with SBP was carried out to improve the results of treatment. Methods. The study included 608 patients with SBP who underwent surgery in a clinical hospital in Russia in 2013-2019. All the patients were divided into groups depending on the method of draining the abdominal cavity and on signs of the purulent process generalization, the marker of which was multiple organ failure. Efficiency of abdominal drainage (by the incidence of TP) and of treatment results (in terms of mortality) were assessed in each group. Results: In patients without signs of the purulent process generalization, drainage of the abdominal cavity with drainage tubes (293 observations) is accompanied by the development of TP in 4.1% of cases and by mortality in 22.9%. If the purulent process is of a generalized nature (315 observations), the incidence of TP increases ten-fold and is 41.9%, and the mortality rate increases 2.7 times and reaches 62.8%. With the generalization of the purulent process, the efficiency of drainage of the abdominal cavity has a significant impact on the results of surgical treatment of patients with SBP. If abdominal drainage is carried out with drainage tubes (129 observations), the incidence of TP is 41.9%, and the mortality rate is 62.8%. Drainage of the abdominal cavity using traditional laparostomy (Bogota bag, 104 cases) is accompanied by the development of TP in 36.5% of cases and mortality in 45.2%. If the abdomen is drained using active laparostomy (VAC-system, 82 observations), the incidence of TP is reduced to 18.3% and mortality to 19.5%. Conclusion. Drainage of the abdominal cavity is the most important stage of surgical intervention in patients with SBP. In cases of the purulent process generalization, drainage of the abdominal cavity in the most effective way– by active laparostomy (VAC-system) will improve the results of treatment of these patients.