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Postoperative Peritonitis: Etiology, Diagnosis, and Treatment

  • Chapter
  • First Online:
Abdominal Sepsis

Part of the book series: Hot Topics in Acute Care Surgery and Trauma ((HTACST))

Abstract

Postoperative peritonitis is still one of the most common causes of postoperative mortality after abdominal surgery. Over the last three decades, improvements in surgical technique and intensive care management have reduced the frequency of postoperative peritonitis, especially after major abdominal surgery. Still, mortality from abdominal sepsis is high, and successful treatment of postoperative peritonitis remains a challenge. Early diagnosis and appropriate and immediate initiation of an effective therapy is the cornerstone of successful treatment of postoperative peritonitis. The treatment of postoperative peritonitis relays on three principles: focus elimination, intensive care management, and antibiotic therapy. While treatment options for source control and intensive care management constantly improved, rapidly continuing emergence of postoperative peritonitis with resistant microorganisms is responsible for an increasing number of treatment failures among surgical patients.

The aim of this book chapter is to describe the most common causes of postoperative peritonitis. Furthermore, we aimed to identify the best strategies to prevent and treat postoperative peritonitis with special attention to antibiotic-resistant microorganisms and treatment options for postoperative peritonitis secondary to antibiotic-resistant microorganisms.

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References

  1. Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369(9):840–51. doi:10.1056/NEJMra1208623. PubMed PMID: 23984731

    Article  CAS  PubMed  Google Scholar 

  2. Slade E, Tamber PS, Vincent JL. The surviving sepsis campaign: raising awareness to reduce mortality. Crit Care. 2003;7(1):1–2. Epub 2003/03/06. PubMed PMID: 12617727; PubMed Central PMCID: PMC154124

    Article  PubMed  PubMed Central  Google Scholar 

  3. Karlsson S, Varpula M, Ruokonen E, Pettila V, Parviainen I, Ala-Kokko TI, et al. Incidence, treatment, and outcome of severe sepsis in ICU-treated adults in Finland: the Finnsepsis study. Intensive Care Med. 2007;33(3):435–43. doi:10.1007/s00134-006-0504-z. PubMed PMID: 17225161 Epub 2007/01/17.

    Article  PubMed  Google Scholar 

  4. Anaya DA, Nathens AB. Risk factors for severe sepsis in secondary peritonitis. Surg Infect. 2003;4(4):355–62.

    Article  Google Scholar 

  5. Hecker A, Uhle F, Schwandner T, Padberg W, Weigand MA. Diagnostics, therapy and outcome prediction in abdominal sepsis: current standards and future perspectives. Langenbeck's Arch Surg. 2014;399(1):11–22.

    Article  CAS  Google Scholar 

  6. Herzog T, Chromik AM, Uhl W. Treatment of complicated intra-abdominal infections in the era of multi-drug resistant bacteria. Eur J Med Res. 2010;15(12):525–32. PubMed PMID: 21163727; PubMed Central PMCID: PMC3352101

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Mazuski JE, Solomkin JS. Intra-abdominal infections. Surg Clin North Am. 2009;89(2):421–37. doi:10.1016/j.suc.2008.12.001. ix. Epub 2009/03/14. PubMed PMID: 19281892

    Article  PubMed  Google Scholar 

  8. Barie PS, Hydo LJ, Eachempati SR. Longitudinal outcomes of intra-abdominal infection complicated by critical illness. Surg Infect. 2004;5(4):365–73. doi:10.1089/sur.2004.5.365. PubMed PMID: 15744128

    Article  Google Scholar 

  9. Ingraham AM, Cohen ME, Bilimoria KY, Pritts TA, Ko CY, Esposito TJ. Comparison of outcomes after laparoscopic versus open appendectomy for acute appendicitis at 222 ACS NSQIP hospitals. Surgery. 2010;148(4):625–35. discussion 35–7. doi:10.1016/j.surg.2010.07.025. PubMed PMID: 20797745

    Article  PubMed  Google Scholar 

  10. Pacelli F, Doglietto GB, Alfieri S, Piccioni E, Sgadari A, Gui D, et al. Prognosis in intra-abdominal infections. Multivariate analysis on 604 patients. Arch Surg. 1996;131(6):641–5.

    Article  CAS  PubMed  Google Scholar 

  11. Pieracci FM, Barie PS. Management of severe sepsis of abdominal origin. Scand J Surg. 2007;96(3):184–96.

    Article  CAS  PubMed  Google Scholar 

  12. Bunchorntavakul C, Chamroonkul N, Chavalitdhamrong D. Bacterial infections in cirrhosis: a critical review and practical guidance. World J Hepatol. 2016;8(6):307–21.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Holzheimer RG, Muhrer KH, L'Allemand N, Schmidt T, Henneking K. Intraabdominal infections: classification, mortality, scoring and pathophysiology. Infection. 1991;19(6):447–52.

    Article  CAS  PubMed  Google Scholar 

  14. De Waele JJ. Abdominal sepsis. Curr Infect Dis Rep. 2016;18(8):016–0531.

    Article  Google Scholar 

  15. Montravers P, Blot S, Dimopoulos G, Eckmann C, Eggimann P, Guirao X, et al. Therapeutic management of peritonitis: a comprehensive guide for intensivists. Intensive Care Med. 2016;42(8):1234–47.

    Article  CAS  PubMed  Google Scholar 

  16. Chromik AM, Meiser A, Holling J, Sulberg D, Daigeler A, Meurer K, et al. Identification of patients at risk for development of tertiary peritonitis on a surgical intensive care unit. J Gastrointest Surg. 2009;13(7):1358–67. doi:10.1007/s11605-009-0882-y. PubMed PMID: 19352781

    Article  PubMed  Google Scholar 

  17. Marshall JC, Innes M. Intensive care unit management of intra-abdominal infection. Crit Care Med. 2003;31(8):2228–37.

    Article  PubMed  Google Scholar 

  18. Frileux P, Attal E, Sarkis R, Parc R. Anastomic dehiscence and severe peritonitis. Infection. 1999;27(1):67–70.

    Article  CAS  PubMed  Google Scholar 

  19. Rickert A, Willeke F, Kienle P, Post S. Management and outcome of anastomotic leakage after colonic surgery. Color Dis. 2010;12(10 Online):e216–23. doi:10.1111/j.1463-1318.2009.02152.x. PubMed PMID: 20002697

    Article  CAS  Google Scholar 

  20. Platt JJ, Ramanathan ML, Crosbie RA, Anderson JH, McKee RF, Horgan PG, et al. C-reactive protein as a predictor of postoperative infective complications after curative resection in patients with colorectal cancer. Ann Surg Oncol. 2012;19(13):4168–77. doi:10.1245/s10434-012-2498-9. PubMed PMID: 22805866

    Article  PubMed  Google Scholar 

  21. Jung B, Molinari N, Nasri M, Hajjej Z, Chanques G, Jean-Pierre H, et al. Procalcitonin biomarker kinetics fails to predict treatment response in perioperative abdominal infection with septic shock. Crit Care. 2013;17(5):R255.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Reith HB, Mittelkotter U, Wagner R, Thiede A. Procalcitonin (PCT) in patients with abdominal sepsis. Intensive Care Med. 2000;26(2):S165–9.

    Article  PubMed  Google Scholar 

  23. Herwig R, Glodny B, Kuhle C, Schluter B, Brinkmann OA, Strasser H, et al. Early identification of peritonitis by peritoneal cytokine measurement. Dis Colon Rectum. 2002;45(4):514–21. PubMed PMID: 12006934

    Article  PubMed  Google Scholar 

  24. Rettig TC, Verwijmeren L, Dijkstra IM, Boerma D, van de Garde EM, Noordzij PG. Postoperative interleukin-6 level and early detection of complications after elective major abdominal surgery. Ann Surg. 2016;263(6):1207–12.

    Article  PubMed  Google Scholar 

  25. Lamazza A, Fiori E, De Masi E, Scoglio D, Sterpetti AV, Lezoche E. Self-expanding metal stents for treatment of anastomotic complications after colorectal resection. Endoscopy. 2013;45(6):493–5.

    Article  CAS  PubMed  Google Scholar 

  26. Smallwood NR, Fleshman JW, Leeds SG, Burdick JS. The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations. Surg Endosc. 2016;30(6):2473–80. doi:10.1007/s00464-015-4501-6. PubMed PMID: 26423414

    Article  PubMed  Google Scholar 

  27. Thornton M, Joshi H, Vimalachandran C, Heath R, Carter P, Gur U, et al. Management and outcome of colorectal anastomotic leaks. Int J Color Dis. 2011;26(3):313–20.

    Article  Google Scholar 

  28. Arezzo A, Verra M, Passera R, Bullano A, Rapetti L, Morino M. Long-term efficacy of endoscopic vacuum therapy for the treatment of colorectal anastomotic leaks. Dig Liver Dis. 2015;47(4):342–5.

    Article  PubMed  Google Scholar 

  29. Phitayakorn R, Delaney CP, Reynolds HL, Champagne BJ, Heriot AG, Neary P, et al. Standardized algorithms for management of anastomotic leaks and related abdominal and pelvic abscesses after colorectal surgery. World J Surg. 2008;32(6):1147–56.

    Article  CAS  PubMed  Google Scholar 

  30. Ulrich AB, Seiler C, Rahbari N, Weitz J, Buchler MW. Diverting stoma after low anterior resection: more arguments in favor. Dis Colon Rectum. 2009;52(3):412–8. doi:10.1007/DCR.0b013e318197e1b1. PubMed PMID: 19333040

    Article  PubMed  Google Scholar 

  31. Bader FG, Schroder M, Kujath P, Muhl E, Bruch HP, Eckmann C. Diffuse postoperative peritonitis — value of diagnostic parameters and impact of early indication for relaparotomy. Eur J Med Res. 2009;14(11):491–6. PubMed PMID: 1994844519948445; PubMed Central PMCID: PMC3352290PMC3352290

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Scialpi M, Scaglione M, Volterrani L, Lupattelli L, Ragozzino A, Romano S, et al. Imaging evaluation of post pancreatic surgery. Eur J Radiol. 2005;53(3):417–24. doi:10.1016/j.ejrad.2004.12.013. PubMed PMID: 15741015

    Article  PubMed  Google Scholar 

  33. Just KS, Defosse JM, Grensemann J, Wappler F, Sakka SG. Computed tomography for the identification of a potential infectious source in critically ill surgical patients. J Crit Care. 2015;30(2):386–9.

    Article  PubMed  Google Scholar 

  34. Herzog T, Deleites C, Belyaev O, Chromik AM, Uhl W. Clostridium difficile in visceral surgery. Chirurg. 2015;86(8):781–6. doi:10.1007/s00104-014-2905-9. PubMed PMID: 25432576

    Article  CAS  PubMed  Google Scholar 

  35. Sohn TA, Yeo CJ, Cameron JL, Geschwind JF, Mitchell SE, Venbrux AC, et al. Pancreaticoduodenectomy: role of interventional radiologists in managing patients and complications. J Gastrointest Surg. 2003;7(2):209–19.

    Article  PubMed  Google Scholar 

  36. Fischer PE, Nunn AM, Wormer BA, Christmas AB, Gibeault LA, Green JM, et al. Vasopressor use after initial damage control laparotomy increases risk for anastomotic disruption in the management of destructive colon injuries. Am J Surg. 2013;206(6):900–3.

    Article  PubMed  Google Scholar 

  37. Gadiot RP, Dunker MS, Mearadji A, Mannaerts GH. Reduction of anastomotic failure in laparoscopic colorectal surgery using antitraction sutures. Surg Endosc. 2011;25(1):68–71.

    Article  PubMed  Google Scholar 

  38. Lipska MA, Bissett IP, Parry BR, Merrie AE. Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg. 2006;76(7):579–85. doi:10.1111/j.1445-2197.2006.03780.x. PubMed PMID: 16813622

    Article  PubMed  Google Scholar 

  39. Strasberg SM, Drebin JA, Mokadam NA, Green DW, Jones KL, Ehlers JP, et al. Prospective trial of a blood supply-based technique of pancreaticojejunostomy: effect on anastomotic failure in the Whipple procedure. J Am Coll Surg. 2002;194(6):746–58.

    Article  PubMed  Google Scholar 

  40. Wittmann DH, Schein M, Condon RE. Management of secondary peritonitis. Ann Surg. 1996;224(1):10–8. PubMed PMID: 8678610; PubMed Central PMCID: PMC1235241

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Mulier S, Penninckx F, Verwaest C, Filez L, Aerts R, Fieuws S, et al. Factors affecting mortality in generalized postoperative peritonitis: multivariate analysis in 96 patients. World J Surg. 2003;27(4):379–84.

    Article  PubMed  Google Scholar 

  42. Herzog T, Belyaev O, Hessam S, Uhl W, Chromik AM. Management of isolated bile leaks after pancreatic resections. J Investig Surg. 2014;27(5):273–81. doi:10.3109/08941939.2014.916368. PubMed PMID: 24830477

    Article  Google Scholar 

  43. Weledji EP, Verla V. Failure to rescue patients from early critical complications of oesophagogastric cancer surgery. Ann Med Surg (Lond). 2016;7:34–41. doi:10.1016/j.amsu.2016.02.027. PubMed PMID: 27054032; PubMed Central PMCID: PMC4802398

    Article  Google Scholar 

  44. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8–13. doi:10.1016/j.surg.2005.05.001. PubMed PMID: 16003309

    Article  PubMed  Google Scholar 

  45. Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery. 2011;149(5):680–8. doi:10.1016/j.surg.2010.12.002. PubMed PMID: 21316725

    Article  PubMed  Google Scholar 

  46. Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147(3):339–51. doi:10.1016/j.surg.2009.10.012. PubMed PMID: 20004450

    Article  PubMed  Google Scholar 

  47. Csendes A, Diaz JC, Burdiles P, Braghetto I, Maluenda F, Nava O, et al. Classification and treatment of anastomotic leakage after extended total gastrectomy in gastric carcinoma. Hepato-Gastroenterology. 1990;37(Suppl 2):174–7. PubMed PMID: 2083933

    PubMed  Google Scholar 

  48. Goenka MK, Goenka U. Endotherapy of leaks and fistula. World J Gastrointest Endosc. 2015;7(7):702–13.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Riss S, Stift A, Meier M, Haiden E, Grunberger T, Bergmann M. Endo-sponge assisted treatment of anastomotic leakage following colorectal surgery. Color Dis. 2010;12(7 Online):1463–318.

    Google Scholar 

  50. Leeds SG, Burdick JS. Management of gastric leaks after sleeve gastrectomy with endoluminal vacuum (E-Vac) therapy. Surg Obes Relat Dis. 2016;21(16):00022–8.

    Google Scholar 

  51. Aurello P, Magistri P, D'Angelo F, Valabrega S, Sirimarco D, Tierno SM, et al. Treatment of esophagojejunal anastomosis leakage: a systematic review from the last two decades. Am Surg. 2015;81(5):450–3. PubMed PMID: 25975326

    PubMed  Google Scholar 

  52. Blumetti J, Chaudhry V, Cintron JR, Park JJ, Marecik S, Harrison JL, et al. Management of anastomotic leak: lessons learned from a large colon and rectal surgery training program. World J Surg. 2014;38(4):985–91.

    Article  PubMed  Google Scholar 

  53. Wormuth JK, Heitmiller RF. Esophageal conduit necrosis. Thorac Surg Clin. 2006;16(1):11–22.

    Article  PubMed  Google Scholar 

  54. Parc Y, Frileux P, Schmitt G, Dehni N, Ollivier JM, Parc R. Management of postoperative peritonitis after anterior resection: experience from a referral intensive care unit. Dis Colon Rectum. 2000;43(5):579–87.

    Article  CAS  PubMed  Google Scholar 

  55. Huang HT, Wang F, Shen L, Xia CQ, Lu CX, Zhong CJ. Clinical outcome of middle thoracic esophageal cancer with intrathoracic or cervical anastomosis. Thorac Cardiovasc Surg. 2015;63(4):328–34. doi:10.1055/s-0034-1371509. PubMed PMID: 24715527

    Article  PubMed  Google Scholar 

  56. Yannopoulos P, Theodoridis P, Manes K. Esophagectomy without thoracotomy: 25 years of experience over 750 patients. Langenbeck’s Arch Surg. 2009;394(4):611–6. doi:10.1007/s00423-009-0488-6. PubMed PMID: 1935026719350267; PubMed Central PMCID: PMC2687514PMC2687514

    Article  Google Scholar 

  57. Markar S, Gronnier C, Duhamel A, Mabrut JY, Bail JP, Carrere N, et al. The impact of severe anastomotic leak on long-term survival and cancer recurrence after surgical resection for esophageal malignancy. Ann Surg. 2015;262(6):972–80. doi:10.1097/SLA.0000000000001011. PubMed PMID: 26469952

    Article  PubMed  Google Scholar 

  58. Andreou A, Biebl M, Dadras M, Struecker B, Sauer IM, Thuss-Patience PC, et al. Anastomotic leak predicts diminished long-term survival after resection for gastric and esophageal cancer. Surgery. 2016;160(1):191–203.

    Article  PubMed  Google Scholar 

  59. Kim RH, Takabe K. Methods of esophagogastric anastomoses following esophagectomy for cancer: a systematic review. J Surg Oncol. 2010;101(6):527–33.

    Article  PubMed  Google Scholar 

  60. Pasquer A, Renaud F, Hec F, Gandon A, Vanderbeken M, Drubay V, et al. Is centralization needed for esophageal and gastric cancer patients with low operative risk? A nationwide study. Ann Surg. 2016;264(5):823–30. doi:10.1097/SLA.0000000000001768. PubMed PMID: 27429033

    Article  PubMed  Google Scholar 

  61. Korolija D. The current evidence on stapled versus hand-sewn anastomoses in the digestive tract. Minim Invasive Ther Allied Technol. 2008;17(3):151–4.

    Article  PubMed  Google Scholar 

  62. Turkyilmaz A, Eroglu A, Aydin Y, Tekinbas C, Muharrem Erol M, Karaoglanoglu N. The management of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. Dis Esophagus. 2009;22(2):119–26. doi:10.1111/j.1442-2050.2008.00866.x. PubMed PMID: 18847447

    Article  CAS  PubMed  Google Scholar 

  63. Messager M, Warlaumont M, Renaud F, Marin H, Branche J, Piessen G, et al. Recent improvements in the management of esophageal anastomotic leak after surgery for cancer. Eur J Surg Oncol. 2017;43(2):258–69. doi:10.1016/j.ejso.2016.06.394. PubMed PMID: 27396305

    Article  CAS  PubMed  Google Scholar 

  64. Gubler C, Schneider PM, Bauerfeind P. Complex anastomotic leaks following esophageal resections: the new stent over sponge (SOS) approach. Dis Esophagus. 2013;26(6):598–602.

    Article  CAS  PubMed  Google Scholar 

  65. Weidenhagen R, Hartl WH, Gruetzner KU, Eichhorn ME, Spelsberg F, Jauch KW. Anastomotic leakage after esophageal resection: new treatment options by endoluminal vacuum therapy. Ann Thorac Surg. 2010;90(5):1674–81.

    Article  PubMed  Google Scholar 

  66. Licht E, Markowitz AJ, Bains MS, Gerdes H, Ludwig E, Mendelsohn RB, et al. Endoscopic management of esophageal anastomotic leaks after surgery for malignant disease. Ann Thorac Surg. 2016;101(1):301–4. doi:10.1016/j.athoracsur.2015.06.072. PubMed PMID: 26428689; PubMed Central PMCID: PMC4910386

    Article  PubMed  Google Scholar 

  67. Dickinson KJ, Blackmon SH. Management of conduit necrosis following esophagectomy. Thorac Surg Clin. 2015;25(4):461–70. doi:10.1016/j.thorsurg.2015.07.008. PubMed PMID: 26515946

    Article  PubMed  Google Scholar 

  68. Dent B, Griffin SM, Jones R, Wahed S, Immanuel A, Hayes N. Management and outcomes of anastomotic leaks after oesophagectomy. Br J Surg. 2016;103(8):1033–8. doi:10.1002/bjs.10175. PubMed PMID: 27146631

    Article  CAS  PubMed  Google Scholar 

  69. Sierzega M, Kolodziejczyk P, Kulig J. Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach. Br J Surg. 2010;97(7):1035–42. doi:10.1002/bjs.7038. PubMed PMID: 20632269

    Article  CAS  PubMed  Google Scholar 

  70. Lang H, Piso P, Stukenborg C, Raab R, Jahne J. Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol. 2000;26(2):168–71. doi:10.1053/ejso.1999.0764. PubMed PMID: 10744938

    Article  CAS  PubMed  Google Scholar 

  71. Meyer L, Meyer F, Dralle H, Ernst M, Lippert H, Gastinger I. Insufficiency risk of esophagojejunal anastomosis after total abdominal gastrectomy for gastric carcinoma. Langenbeck’s Arch Surg. 2005;390(6):510–6. doi:10.1007/s00423-005-0575-2. PubMed PMID: 16086189

    Article  CAS  Google Scholar 

  72. Kim KH, Kim MC, Jung GJ. Risk factors for duodenal stump leakage after gastrectomy for gastric cancer and management technique of stump leakage. Hepato-Gastroenterology. 2014;61(133):1446–53. PubMed PMID: 25436323

    PubMed  Google Scholar 

  73. Cozzaglio L, Coladonato M, Biffi R, Coniglio A, Corso V, Dionigi P, et al. Duodenal fistula after elective gastrectomy for malignant disease : an italian retrospective multicenter study. J Gastrointest Surg. 2010;14(5):805–11. doi:10.1007/s11605-010-1166-2. PubMed PMID: 20143272

    Article  PubMed  Google Scholar 

  74. Telem DA, Sur M, Tabrizian P, Chao TE, Nguyen SQ, Chin EH, et al. Diagnosis of gastrointestinal anastomotic dehiscence after hospital discharge: impact on patient management and outcome. Surgery. 2010;147(1):127–33. doi:10.1016/j.surg.2009.06.034. PubMed PMID: 19767052

    Article  PubMed  Google Scholar 

  75. Lee S, Carmody B, Wolfe L, Demaria E, Kellum JM, Sugerman H, et al. Effect of location and speed of diagnosis on anastomotic leak outcomes in 3828 gastric bypass cases. J Gastrointest Surg. 2007;11(6):708–13. doi:10.1007/s11605-007-0085-3. PubMed PMID: 17562118

    Article  PubMed  Google Scholar 

  76. Hori S, Ochiai T, Gunji Y, Hayashi H, Suzuki T. A prospective randomized trial of hand-sutured versus mechanically stapled anastomoses for gastroduodenostomy after distal gastrectomy. Gastric Cancer. 2004;7(1):24–30. doi:10.1007/s10120-003-0263-2. PubMed PMID: 15052436

    Article  PubMed  Google Scholar 

  77. Kim SH, Son SY, Park YS, Ahn SH, Park-do J, Kim HH. Risk factors for anastomotic leakage: a retrospective cohort study in a single gastric surgical unit. J Gastr Cancer. 2015;15(3):167–75. doi:10.5230/jgc.2015.15.3.167. PubMed PMID: 26468414; PubMed Central PMCID: PMC4604331

    Article  Google Scholar 

  78. Sorensen LT, Jorgensen T, Kirkeby LT, Skovdal J, Vennits B, Wille-Jorgensen P. Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br J Surg. 1999;86(7):927–31. doi:10.1046/j.1365-2168.1999.01165.x. PubMed PMID: 10417567

    Article  CAS  PubMed  Google Scholar 

  79. Hoeppner J, Kulemann B, Seifert G, Marjanovic G, Fischer A, Hopt UT, et al. Covered self-expanding stent treatment for anastomotic leakage: outcomes in esophagogastric and esophagojejunal anastomoses. Surg Endosc. 2014;28(5):1703–11. doi:10.1007/s00464-013-3379-4. PubMed PMID: 24380994

    Article  PubMed  Google Scholar 

  80. Aurello P, Sirimarco D, Magistri P, Petrucciani N, Berardi G, Amato S, et al. Management of duodenal stump fistula after gastrectomy for gastric cancer: systematic review. World J Gastroenterol. 2015;21(24):7571–6. doi:10.3748/wjg.v21.i24.7571. PubMed PMID: 26140005; PubMed Central PMCID: PMC4481454

    Article  PubMed  PubMed Central  Google Scholar 

  81. Baraza W, Wild J, Barber W, Brown S. Postoperative management after loop ileostomy closure: are we keeping patients in hospital too long? Ann R Coll Surg Engl. 2010;92(1):51–5. doi:10.1308/003588410X12518836439209. PubMed PMID: 20056062; PubMed Central PMCID: PMC3024618

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Loffler T, Rossion I, Bruckner T, Diener MK, Koch M, von Frankenberg M, et al. HAnd Suture Versus STApling for Closure of Loop Ileostomy (HASTA trial): results of a multicenter randomized trial (DRKS00000040). Ann Surg. 2012;256(5):828–35. discussion 35–6. doi:10.1097/SLA.0b013e318272df97. PubMed PMID: 23095628

    Article  PubMed  Google Scholar 

  83. Simillis C, Purkayastha S, Yamamoto T, Strong SA, Darzi AW, Tekkis PP. A meta-analysis comparing conventional end-to-end anastomosis vs. other anastomotic configurations after resection in Crohn’s disease. Dis Colon Rectum. 2007;50(10):1674–87. doi:10.1007/s10350-007-9011-8. PubMed PMID: 17682822

    Article  PubMed  Google Scholar 

  84. Resegotti A, Astegiano M, Farina EC, Ciccone G, Avagnina G, Giustetto A, et al. Side-to-side stapled anastomosis strongly reduces anastomotic leak rates in Crohn’s disease surgery. Dis Colon Rectum. 2005;48(3):464–8. doi:10.1007/s10350-004-0786-6. PubMed PMID: 15719193

    Article  PubMed  Google Scholar 

  85. Nasirkhan MU, Abir F, Longo W, Kozol R. Anastomotic disruption after large bowel resection. World J Gastroenterol. 2006;12(16):2497–504. PubMed PMID: 16688793; PubMed Central PMCID: PMC4087980

    Article  PubMed  PubMed Central  Google Scholar 

  86. Kingham TP, Pachter HL. Colonic anastomotic leak: risk factors, diagnosis, and treatment. J Am Coll Surg. 2009;208(2):269–78. doi:10.1016/j.jamcollsurg.2008.10.015. PubMed PMID: 19228539

    Article  PubMed  Google Scholar 

  87. Boccola MA, Buettner PG, Rozen WM, Siu SK, Stevenson AR, Stitz R, et al. Risk factors and outcomes for anastomotic leakage in colorectal surgery: a single-institution analysis of 1576 patients. World J Surg. 2011;35(1):186–95. doi:10.1007/s00268-010-0831-7. PubMed PMID: 20972678

    Article  PubMed  Google Scholar 

  88. Trencheva K, Morrissey KP, Wells M, Mancuso CA, Lee SW, Sonoda T, et al. Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients. Ann Surg. 2013;257(1):108–13. doi:10.1097/SLA.0b013e318262a6cd. PubMed PMID: 22968068

    Article  PubMed  Google Scholar 

  89. Hyman N, Manchester TL, Osler T, Burns B, Cataldo PA. Anastomotic leaks after intestinal anastomosis: it’s later than you think. Ann Surg. 2007;245(2):254–8. doi:10.1097/01.sla.0000225083.27182.85. PubMed PMID: 17245179; PubMed Central PMCID: PMC1876987

    Article  PubMed  PubMed Central  Google Scholar 

  90. Majbar MA, Elmalki Hadj O, Souadka A, El Alaoui M, Sabbah F, Raiss M, et al. Risk factors for anastomotic leakage after anterior resection for rectal adenocarcinoma. Tun Med. 2014;92(7):493–6. PubMed PMID: 25775290

    Google Scholar 

  91. Yeo HL, Abelson JS, Mao J, O'Mahoney PR, Milsom JW, Sedrakyan A. Surgeon annual and cumulative volumes predict early postoperative outcomes after rectal cancer resection. Ann Surg. 2016; doi:10.1097/SLA.0000000000001672. PubMed PMID: 26891249

  92. Qu H, Liu Y, Bi DS. Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systematic review and meta-analysis. Surg Endosc. 2015;29(12):3608–17. doi:10.1007/s00464-015-4117-x. PubMed PMID: 25743996

    Article  PubMed  Google Scholar 

  93. Kim CW, Baek SJ, Hur H, Min BS, Baik SH, Kim NK. Anastomotic leakage after low anterior resection for rectal cancer is different between minimally invasive surgery and open surgery. Ann Surg. 2016;263(1):130–7. doi:10.1097/SLA.0000000000001157. PubMed PMID: 25692355

    Article  PubMed  Google Scholar 

  94. Kaur P, Karandikar SS, Roy-Choudhury S. Accuracy of multidetector CT in detecting anastomotic leaks following stapled left-sided colonic anastomosis. Clin Radiol. 2014;69(1):59–62. doi:10.1016/j.crad.2013.08.006. PubMed PMID: 24156793

    Article  CAS  PubMed  Google Scholar 

  95. de Castro SM, Kuhlmann KF, Busch OR, van Delden OM, Lameris JS, van Gulik TM, et al. Incidence and management of biliary leakage after hepaticojejunostomy. J Gastrointest Surg. 2005;9(8):1163–71; discussion 71–3. doi:10.1016/j.gassur.2005.08.010. PubMed PMID: 16269388

    Article  PubMed  Google Scholar 

  96. Antolovic D, Koch M, Galindo L, Wolff S, Music E, Kienle P, et al. Hepaticojejunostomy—analysis of risk factors for postoperative bile leaks and surgical complications. J Gastrointest Surg. 2007;11(5):555–61. doi:10.1007/s11605-007-0166-3. PubMed PMID: 17394045

    Article  PubMed  Google Scholar 

  97. Herzog T, Suelberg D, Belyaev O, Uhl W, Seemann M, Seelig MH. Treatment of acute delayed visceral hemorrhage after pancreatic surgery from hepatic arteries with covered stents. J Gastrointest Surg. 2011;15(3):496–502. doi:10.1007/s11605-010-1260-5. PubMed PMID: 21240640

    Article  PubMed  Google Scholar 

  98. Duconseil P, Turrini O, Ewald J, Berdah SV, Moutardier V, Delpero JR. Biliary complications after pancreaticoduodenectomy: skinny bile ducts are surgeons’ enemies. World J Surg. 2014;38(11):2946–51. doi:10.1007/s00268-014-2698-5. PubMed PMID: 25011578

    Article  PubMed  Google Scholar 

  99. Herzog T, Belyaev O, Bakowski P, Chromik AM, Janot M, Suelberg D, et al. The difficult hepaticojejunostomy after pancreatic head resection: reconstruction with a T tube. Am J Surg. 2013;206(4):578–85. doi:10.1016/j.amjsurg.2013.01.044. PubMed PMID: 23906984

    Article  PubMed  Google Scholar 

  100. Kobryn K, Koziel S, Porecka M, Holowko W, Patkowski W, Zieniewicz K, et al. Endoscopic treatment of early biliary complications in liver transplant recipients. Ann Transplant. 2015;20:741–6. PubMed PMID: 26666997

    Article  PubMed  Google Scholar 

  101. Burkhart RA, Relles D, Pineda DM, Gabale S, Sauter PK, Rosato EL, et al. Defining treatment and outcomes of hepaticojejunostomy failure following pancreaticoduodenectomy. J Gastrointest Surg. 2013;17(3):451–60. doi:10.1007/s11605-012-2118-9.

    Article  PubMed  Google Scholar 

  102. Machado NO. Pancreatic fistula after pancreatectomy: definitions, risk factors, preventive measures, and management-review. Int J Surg Oncol. 2012;602478(10):24.

    Google Scholar 

  103. Darnis B, Lebeau R, Chopin-Laly X, Adham M. Postpancreatectomy hemorrhage (PPH): predictors and management from a prospective database. Langenbeck's Arch Surg. 2013;398(3):441–8.

    Article  CAS  Google Scholar 

  104. Fuks D, Piessen G, Huet E, Tavernier M, Zerbib P, Michot F, et al. Life-threatening postoperative pancreatic fistula (grade C) after pancreaticoduodenectomy: incidence, prognosis, and risk factors. Am J Surg. 2009;197(6):702–9.

    Article  PubMed  Google Scholar 

  105. Malleo G, Crippa S, Butturini G, Salvia R, Partelli S, Rossini R, et al. Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: validation of International Study Group of Pancreatic Surgery classification and analysis of risk factors. HPB (Oxford). 2010;12(9):610–8.

    Article  Google Scholar 

  106. Park JS, Hwang HK, Kim JK, Cho SI, Yoon DS, Lee WJ, et al. Clinical validation and risk factors for delayed gastric emptying based on the International Study Group of Pancreatic Surgery (ISGPS) Classification. Surgery. 2009;146(5):882–7.

    Article  PubMed  Google Scholar 

  107. Ansorge C, Strommer L, Andren-Sandberg A, Lundell L, Herrington MK, Segersvard R. Structured intraoperative assessment of pancreatic gland characteristics in predicting complications after pancreaticoduodenectomy. Br J Surg. 2012;99(8):1076–82.

    Article  CAS  PubMed  Google Scholar 

  108. Erkan M, Hausmann S, Michalski CW, Schlitter AM, Fingerle AA, Dobritz M, et al. How fibrosis influences imaging and surgical decisions in pancreatic cancer. Front Physiol. 2012;3:389.

    Article  PubMed  PubMed Central  Google Scholar 

  109. Murakami Y, Uemura K, Hayasidani Y, Sudo T, Hashimoto Y, Nakagawa N, et al. A soft pancreatic remnant is associated with increased drain fluid pancreatic amylase and serum CRP levels following pancreatoduodenectomy. J Gastrointest Surg. 2008;12(1):51–6.

    Article  PubMed  Google Scholar 

  110. Popiela T, Kedra B, Sierzega M, Gurda A. Risk factors of pancreatic fistula following pancreaticoduodenectomy for periampullary cancer. Hepato-Gastroenterology. 2004;51(59):1484–8.

    PubMed  Google Scholar 

  111. Belyaev O, Munding J, Herzog T, Suelberg D, Tannapfel A, Schmidt WE, et al. Histomorphological features of the pancreatic remnant as independent risk factors for postoperative pancreatic fistula: a matched-pairs analysis. Pancreatology. 2011;11(5):516–24. doi:10.1159/000332587. PubMed PMID: 22056514

    Article  PubMed  Google Scholar 

  112. Belyaev O, Rosenkranz S, Munding J, Herzog T, Chromik AM, Tannapfel A, et al. Quantitative assessment and determinants of suture-holding capacity of human pancreas. J Surg Res. 2013;184(2):807–12. doi:10.1016/j.jss.2013.04.017. PubMed PMID: 23663821

    Article  PubMed  Google Scholar 

  113. Muller MW, Friess H, Kleeff J, Dahmen R, Wagner M, Hinz U, et al. Is there still a role for total pancreatectomy? Ann Surg. 2007;246(6):966–74; discussion 74–5. doi:10.1097/SLA.0b013e31815c2ca3. PubMed PMID: 18043098

    Article  PubMed  Google Scholar 

  114. Nakatsuka A, Yamaguchi K, Chijiiwa K, Tanaka M. Octreotide inhibits pancreatic exocrine secretion and prevents pancreatoenterostomy leakage. Int Surg. 2000;85(2):124–9. PubMed PMID: 11071328

    CAS  PubMed  Google Scholar 

  115. Gurusamy KS, Koti R, Fusai G, Davidson BR. Somatostatin analogues for pancreatic surgery. Cochrane Database Syst Rev. 2013;4:CD008370. doi:10.1002/14651858.CD008370.pub3. PubMed PMID: 23633353

    Google Scholar 

  116. Limongelli P, Khorsandi SE, Pai M, Jackson JE, Tait P, Tierris J, et al. Management of delayed postoperative hemorrhage after pancreaticoduodenectomy: a meta-analysis. Arch Surg. 2008;143(10):1001–7. doi:10.1001/archsurg.143.10.1001. PubMed PMID: 18936380

    Article  PubMed  Google Scholar 

  117. Roulin D, Cerantola Y, Demartines N, Schafer M. Systematic review of delayed postoperative hemorrhage after pancreatic resection. J Gastrointest Surg. 2011;15(6):1055–62. doi:10.1007/s11605-011-1427-8. PubMed PMID: 21267670

    Article  PubMed  Google Scholar 

  118. Gueroult S, Parc Y, Duron F, Paye F, Parc R. Completion pancreatectomy for postoperative peritonitis after pancreaticoduodenectomy: early and late outcome. Arch Surg. 2004;139(1):16–9.

    Article  PubMed  Google Scholar 

  119. Paugam-Burtz C, Dupont H, Marmuse JP, Chosidow D, Malek L, Desmonts JM, et al. Daily organ-system failure for diagnosis of persistent intra-abdominal sepsis after postoperative peritonitis. Intensive Care Med. 2002;28(5):594–8.

    Article  CAS  PubMed  Google Scholar 

  120. Vandervelden S, Malbrain ML. Initial resuscitation from severe sepsis: one size does not fit all. Anaesthesiol Intensive Ther. 2015;47(s44):18.

    Google Scholar 

  121. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–77. doi:10.1056/NEJMoa010307. PubMed PMID: 11794169

    Article  CAS  PubMed  Google Scholar 

  122. Malbrain ML, Marik PE, Witters I, Cordemans C, Kirkpatrick AW, Roberts DJ, et al. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther. 2014;46(5):361–80.

    Article  PubMed  Google Scholar 

  123. Hasanin A. Fluid responsiveness in acute circulatory failure. J Intensive Care. 2015;3:50. doi:10.1186/s40560-015-0117-0. PubMed PMID: 26594361; PubMed Central PMCID: PMC4653888

    Article  PubMed  PubMed Central  Google Scholar 

  124. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589–96. doi:10.1097/01.CCM.0000217961.75225.E9. PubMed PMID: 16625125

    Article  PubMed  Google Scholar 

  125. Mazuski JE. Antimicrobial treatment for intra-abdominal infections. Expert Opin Pharmacother. 2007;8(17):2933–45. doi:10.1517/14656566.8.17.2933. PubMed PMID: 18001254

    Article  CAS  PubMed  Google Scholar 

  126. Nicoletti G, Nicolosi D, Rossolini GM, Stefani S. Intra-abdominal infections: etiology, epidemiology, microbiological diagnosis and antibiotic resistance. J Chemother. 2009;21(Suppl 1):5–11. PubMed PMID: 19622445

    Article  PubMed  Google Scholar 

  127. Singh AV, Mishra B, Thakur A. Multidrug-resistant Gram-negative bacteria in postoperative infections. J Indian Med Assoc. 2009;107(3):148–50, 63. PubMed PMID: 19810380

    PubMed  Google Scholar 

  128. Falagas ME, Tansarli GS, Karageorgopoulos DE, Vardakas KZ. Deaths attributable to carbapenem-resistant Enterobacteriaceae infections. Emerg Infect Dis. 2014;20(7):1170–5.

    Article  PubMed  PubMed Central  Google Scholar 

  129. Dupont H, Paugam-Burtz C, Muller-Serieys C, Fierobe L, Chosidow D, Marmuse JP, et al. Predictive factors of mortality due to polymicrobial peritonitis with Candida isolation in peritoneal fluid in critically ill patients. Arch Surg. 2002;137(12):1341–6; discussion 7. PubMed PMID: 12470095

    Article  PubMed  Google Scholar 

  130. Kaki R, Elligsen M, Walker S, Simor A, Palmay L, Daneman N. Impact of antimicrobial stewardship in critical care: a systematic review. J Antimicrob Chemother. 2011;66(6):1223–30.

    Article  CAS  PubMed  Google Scholar 

  131. Sandiumenge A, Diaz E, Bodi M, Rello J. Therapy of ventilator-associated pneumonia. A patient-based approach based on the ten rules of “The Tarragona Strategy”. Intensive Care Med. 2003;29(6):876–83. doi:10.1007/s00134-003-1715-1. PubMed PMID: 12677369

    Article  PubMed  Google Scholar 

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Both authors certify that they do not have any conflict of interest or financial association conflicting with the presented manuscript.

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  1. Department of Surgery, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany

    Torsten Herzog M.D., Ph.D. & Waldemar Uhl M.D., Ph.D.

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  1. Torsten Herzog M.D., Ph.D.
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  2. Waldemar Uhl M.D., Ph.D.
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Correspondence to Torsten Herzog M.D., Ph.D. .

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  1. Department of Surgery, Macerata Hospital, Macerata, Italy

    Massimo Sartelli

  2. University of Udine, Infectious Diseases Division , Udine, Italy

    Matteo Bassetti

  3. St James's University Hospital, Trinity Centre for Health Sciences , Dublin, Ireland

    Ignacio Martin-Loeches

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Herzog, T., Uhl, W. (2018). Postoperative Peritonitis: Etiology, Diagnosis, and Treatment. In: Sartelli, M., Bassetti, M., Martin-Loeches, I. (eds) Abdominal Sepsis. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-319-59704-1_12

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