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Staged lavage versus single high-volume lavage in the treatment of feculent/purulent peritonitis: a matched pair analysis

  • Current Concepts in Clinical Surgery
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Abstract

Background

Spontaneous and iatrogenic secondary peritonitis remain to have a mortality of 10–30% and significant socioeconomic impact in survivors and especially non-survivors. Data on the most cost-effective treatment are lacking. We therefore studied outcome and resource utilization in a homogeneous cohort of patients with secondary fecal or purulent peritonitis undergoing surgery with source control and two different types of abdominal lavage.

Methods

Thirty-one consecutive patients with secondary feculent or purulent peritonitis of the lower gastrointestinal tract underwent a single high-volume lavage. That cohort was matched with 31 patients with the same source, extent, and quality of peritonitis treated by source control and staged lavage (intermittent lavage).

Results

Patients in both groups were comparable in gender distribution, age, comorbidity, source, extent, and severity of peritonitis with the history of intestinal perforation in the single high-volume lavage group being significantly higher than in the intermittent lavage group (2.0 ± 1.7 vs. 1.1 ± 0.8d; p = 0.008). Patients in the single high-volume lavage group had significantly less operations, thus requiring significantly less operation time (OR-time), intensive care unit (ICU)-requirement, ventilatory support, and inotropic support.

Conclusion

Patients with secondary fecal or purulent peritonitis in at least two quadrants, undergoing a one step surgical repair including source control, primary anastomosis, and single high-volume lavage with more than 25 l have a comparable outcome to patients treated by staged lavage at significantly lower OR and ICU-utilization.

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Acknowledgements

The excellent secretarial assistance of I. Metzger is greatly appreciated.

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Authors and Affiliations

  1. Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, 66421, Homburg, Saarland, Germany

    Mohammed R. Moussavian, Sven Richter, Otto Kollmar, Jochen Schuld & Martin K. Schilling

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  1. Mohammed R. Moussavian
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  2. Sven Richter
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  3. Otto Kollmar
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  4. Jochen Schuld
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  5. Martin K. Schilling
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Correspondence to Martin K. Schilling.

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Moussavian, M.R., Richter, S., Kollmar, O. et al. Staged lavage versus single high-volume lavage in the treatment of feculent/purulent peritonitis: a matched pair analysis. Langenbecks Arch Surg 394, 215–220 (2009). https://doi.org/10.1007/s00423-008-0444-x

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