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Sequential abdominal reexploration with the zipper technique

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Abstract

Frequently, several multiple abdominal reexplorations are needed in patients with acute necrotizing hemorrhagic pancreatitis (ANP) or with persistent intraabdominal sepsis (PIAS). Residual undrained necrotic and septic foci lead to multiple organ failure. To provide wide-open drainage of the abdominal cavity, since 1985 we have performed sequential abdominal reexploration with the zipper technique (SARZT) in 24 patients.

Apache II score was used to evaluate expected mortality. In the pancreatic necrosis group, with a mean Apache II score of 31, the expected and the observed mortality were 70% and 29%, respectively. In the PIAS group, with a mean Apache II score of 30, the expected and observed mortality were 60 and 28%, respectively. These results are attributed to the sequential reexploration of the abdominal cavity that permits excision and drainage of necrotic and septic foci.

Résumé

Chez le patient qui a une pancréatite nécrosante (PN) ou une sepsis abdominale persistante (SAP), plusieurs interventions exploratrices sont parfois nécessaires. La persistance de foyers de nécrose ou d'infection peut provoquer une défaillance polyviscérale. Pour permettre, dans ces cas, un drainage large de la cavité abdominale, nous avons pratiqué une ré-exploration répétée systématique avec la technique de fermeture éclair (SARZT) chez 24 patients depuis 1985.

Le score Apache II était utilisé pour évaluer la mortalité attendue. Dans le groupe de patients avec une pancréatite aiguË, le score d'Apache II moyen était de 31; la mortalité attendue était de 70%, la mortalité réelle de 29%. Dans le groupe de patients avec SAP, le score Apache II moyen était de 30, la mortalité attendue de 60% et la mortalité réelle de 28%. Ces résultats favorables sont attribués à la technique de réexploration répétée de la cavité abdominale qui permet l'excision et le drainage efficace de tout foyer de nécrose ou de sepsis.

Resumen

Con frecuencia se requieren reexploraciones abdominales repetidas en pacientes con pancreatitis necrotizante hemorrágica (PNH) o con sepsis intra-abdominal persistente (SIAP). Focos necróticos y sépticos residuales no drenados inducen falla orgánica mÚltiple. Con el objeto de proveer drenaje abierto amplio de la cavidad abdominal, hemos realizado desde 1985 la reexploración abdominal secuencial por medio de la técnica del zipper en 24 pacientes.

Se utilizó el puntaje APACHE II para hacer la valorización de la mortalidad previsible. En el grupo de pacientes con necrosis pancreática el puntaje APACHE II promedio fue 31, y las tasas de mortalidad previsible y de mortalidad real fueron 70% y 29%, respectivamente. En el grupo con SIAP, con un puntaje APACHE II promedio de 30, las tasas de mortalidad previsible y de mortalidad real fueron 60% y 28%, respectivamente. Se atribuyen estos resultados a las reexploraciones secuenciales de la cavidad abdominal, las cuales permiten la remoción y drenaje de focos necróticos y sépticos.

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Authors and Affiliations

  1. Department of Surgery, Hospital Virgen de la Salud, Toledo, Spain

    M. A. Cuesta M.D., Ph.D., M. Doblas M.D., L. Casta∼neda M.D. & E. Bengoechea M.D., Ph.D., F.R.C.S. (Eng.)

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  1. M. A. Cuesta M.D., Ph.D.
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  2. M. Doblas M.D.
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  3. L. Casta∼neda M.D.
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  4. E. Bengoechea M.D., Ph.D., F.R.C.S. (Eng.)
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Cuesta, M.A., Doblas, M., Casta∼neda, L. et al. Sequential abdominal reexploration with the zipper technique. World J. Surg. 15, 74–80 (1991). https://doi.org/10.1007/BF01658968

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