Skip to main content
SpringerLink
Log in

Postoperative Peritonitis After Digestive Tract Surgery: Surgical Management and Risk Factors for Morbidity and Mortality, a Cohort of 191 Patients

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Postoperative peritonitis (POP) following gastrointestinal surgery is associated with significant morbidity and mortality, with no clear management option proposed. The aim of this study was to report our surgical management of POP and identify pre- and perioperative risk factors for morbidity and mortality.

Methods

All patients with POP undergoing relaparotomy in our department between January 2004 and December 2013 were included. Pre- and perioperative data were analyzed to identify predictors of morbidity and mortality.

Results

A total of 191 patients required relaparotomy for POP, of which 16.8% required >1 reinterventions. The commonest cause of POP was anastomotic leakage (66.5%) followed by perforation (20.9%). POP was mostly treated by anastomotic takedown (51.8%), suture with derivative stoma (11.5%), enteral resection and stoma (12%), drainage of the leak (8.9%), stoma on perforation (8.4%), duodenal intubation (7.3%) or intubation of the leak (3.1%). The overall mortality rate was 14%, of which 40% died within the first 48 h. Major complications (Dindo–Clavien > 2) were seen in 47% of the cohort. Stoma formation occurred in 81.6% of patients following relaparotomy. Independent risk factors for mortality were: ASA > 2 (OR = 2.75, 95% CI = 1.07–7.62, p = 0.037), multiorgan failure (MOF) (OR = 5.22, 95% CI = 2.11–13.5, p = 0.0037), perioperative transfusion (OR = 2.7, 95% CI = 1.05–7.47, p = 0.04) and upper GI origin (OR = 3.55, 95% CI = 1.32–9.56, p = 0.013). Independent risk factors for morbidity were: MOF (OR = 2.74, 95% CI = 1.26–6.19, p = 0.013), upper GI origin (OR = 3.74, 95% CI = 1.59–9.44, p = 0.0034) and delayed extubation (OR = 0.27, 95% CI = 0.14–0.55, p = 0.0027).

Conclusion

Mortality following POP remains a significant issue; however, it is decreasing due to effective and aggressive surgical intervention. Predictors of poor outcomes will help tailor management options.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Martinez-Casas I, Sancho JJ, Nve E et al (2010) Preoperative risk factors for mortality after relaparotomy: analysis of 254 patients. Langenbeck’s Arch Surg 395:527–534

    Article  Google Scholar 

  2. Kirshtein B, Roy-Shapira A, Domchik S et al (2008) Early relaparoscopy for management of suspected postoperative complications. J Gastrointest 12:1257–1262

    Article  Google Scholar 

  3. Mulier S, Penninckx F, Verwaest C et al (2003) Factors affecting mortality in generalized postoperative peritonitis: multivariate analysis in 96 patients. World J Surg 27:379–384. https://doi.org/10.1007/s00268-002-6705-x

    Article  Google Scholar 

  4. Riche FC, Dray X, Laisne MJ et al (2009) Factors associated with septic shock and mortality in generalized peritonitis: comparison between community-acquired and postoperative peritonitis. Crit Care 13:R99

    Article  Google Scholar 

  5. Montravers P, Gauzit R, Muller C et al (1996) Emergence of antibiotic-resistant bacteria in cases of peritonitis after intraabdominal surgery affects the efficacy of empirical antimicrobial therapy. Clin Infect Dis 23:486–494

    Article  CAS  Google Scholar 

  6. Roehrborn A, Thomas L, Potreck O et al (2001) The microbiology of postoperative peritonitis. Clin Infect Dis 33:1513–1519

    Article  CAS  Google Scholar 

  7. Turrentine FE, Denlinger CE, Simpson VB et al (2015) Morbidity, mortality, cost, and survival estimates of gastrointestinal anastomotic leaks. J Am Coll Surg 220:195–206

    Article  Google Scholar 

  8. Cozzaglio L, Giovenzana M, Biffi R et al (2016) Surgical management of duodenal stump fistula after elective gastrectomy for malignancy: an Italian retrospective multicenter study. Gastric Cancer 19:273–279

    Article  Google Scholar 

  9. Montravers P, Dupont H, Gauzit R et al (2006) Candida as a risk factor for mortality in peritonitis. Crit Care Med 34:646–652

    Article  Google Scholar 

  10. Koperna T, Schulz G (2000) Relaparotomy in peritonitis: prognosis and treatment of patients with persisting intraabdominal infection. World J Surg 24:32–37. https://doi.org/10.1007/s002689910007

    Article  CAS  Google Scholar 

  11. Linder MM, Wacha H, Feldmann U et al (1987) The Mannheim peritonitis index. An instrument for the intraoperative prognosis of peritonitis. Chirurg 58:84–92

    CAS  PubMed  Google Scholar 

  12. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  13. Parc Y, Frileux P, Vaillant JC et al (1999) Postoperative peritonitis originating from the duodenum: operative management by intubation and continuous intraluminal irrigation. Br J Surg 86:1207–1212

    Article  CAS  Google Scholar 

  14. Canard G, Lefevre JH, Lefevre Y (2013) Management of duodenal perforation or fistula by intubation with the Levy drain. Surgical technique and postoperative management. J Visc Surg 150:115–119

    Article  CAS  Google Scholar 

  15. Parc Y, Frileux P, Schmitt G et al (2000) Management of postoperative peritonitis after anterior resection: experience from a referral intensive care unit. Dis Colon Rectum 43:579–587 (discussion 587-579)

    Article  CAS  Google Scholar 

  16. Dupont H, Bourichon A, Paugam-Burtz C et al (2003) Can yeast isolation in peritoneal fluid be predicted in intensive care unit patients with peritonitis? Crit Care Med 31:752–757

    Article  Google Scholar 

  17. Calicis B, Parc Y, Caplin S et al (2002) Treatment of postoperative peritonitis of small-bowel origin with continuous enteral nutrition and succus entericus reinfusion. Arch Surg 137:296–300

    Article  CAS  Google Scholar 

  18. Sakran N, Goitein D, Raziel A et al (2013) Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc 27:240–245

    Article  Google Scholar 

  19. Jacobsen HJ, Nergard BJ, Leifsson BG et al (2014) Management of suspected anastomotic leak after bariatric laparoscopic Roux-en-y gastric bypass. Br J Surg 101:417–423

    Article  CAS  Google Scholar 

  20. Knaus WA, Draper EA, Wagner DP et al (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829

    Article  CAS  Google Scholar 

  21. Launey Y, Duteurtre B, Larmet R et al (2017) Risk factors for mortality in postoperative peritonitis in critically ill patients. World J Crit Care Med 6:48–55

    Article  Google Scholar 

  22. Bennis M, Parc Y, Lefevre JH et al (2012) Morbidity risk factors after low anterior resection with total mesorectal excision and coloanal anastomosis: a retrospective series of 483 patients. Ann Surg 255:504–510

    Article  Google Scholar 

  23. Glance LG, Dick AW, Mukamel DB et al (2011) Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery. Anesthesiology 114:283–292

    Article  Google Scholar 

  24. Bernard AC, Davenport DL, Chang PK et al (2009) Intraoperative transfusion of 1 U to 2 U packed red blood cells is associated with increased 30-day mortality, surgical-site infection, pneumonia, and sepsis in general surgery patients. J Am Coll Surg 208:931–937 (discussion 938-939)

    Article  Google Scholar 

  25. Al-Refaie WB, Parsons HM, Markin A et al (2012) Blood transfusion and cancer surgery outcomes: a continued reason for concern. Surgery 152(344):354

    Google Scholar 

  26. Li L, Zhu D, Chen X et al (2015) Perioperative allogenenic blood transfusion is associated with worse clinical outcome for patients undergoing gastric carcinoma surgery: a meta-analysis. Med (Baltim) 94:e1574

    Article  Google Scholar 

  27. Fragkou PC, Torrance HD, Pearse RM et al (2014) Perioperative blood transfusion is associated with a gene transcription profile characteristic of immunosuppression: a prospective cohort study. Crit Care 18:541

    Article  Google Scholar 

  28. Tartter PI (1995) Immunologic effects of blood transfusion. Immunol Invest 24:277–288

    Article  CAS  Google Scholar 

  29. Wada H, Matsumoto T, Yamashita Y (2014) Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines. J Intensive Care 2:15

    Article  Google Scholar 

  30. Heredia-Rodriguez M, Pelaez MT, Fierro I et al (2016) Impact of ventilator-associated pneumonia on mortality and epidemiological features of patients with secondary peritonitis. Ann Intensive Care 6:34

    Article  Google Scholar 

  31. Burtin C, Clerckx B, Robbeets C et al (2009) Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med 37:2499–2505

    Article  Google Scholar 

  32. Schweickert WD, Pohlman MC, Pohlman AS et al (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 373:1874–1882

    Article  Google Scholar 

  33. Pitel S, Lefevre JH, Tiret E et al (2012) Redo coloanal anastomosis: a retrospective study of 66 patients. Ann Surg 256:806–810 (discussion 810-801)

    Article  Google Scholar 

  34. Lefevre JH, Bretagnol F, Maggiori L et al (2011) Redo surgery for failed colorectal or coloanal anastomosis: a valuable surgical challenge. Surgery 149:65–71

    Article  Google Scholar 

  35. Maggiori L, Bretagnol F, Lefevre JH et al (2011) Conservative management is associated with a decreased risk of definitive stoma after anastomotic leakage complicating sphincter-saving resection for rectal cancer. Colorectal Dis 13:632–637

    Article  CAS  Google Scholar 

  36. Fucini C, Gattai R, Urena C et al (2008) Quality of life among five-year survivors after treatment for very low rectal cancer with or without a permanent abdominal stoma. Ann Surg Oncol 15:1099–1106

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France

    Thierry Bensignor, Jérémie H. Lefevre, Najim Chafai, Thévy Hor, Clotilde Debove, François Paye, Pierre Balladur, Emmanuel Tiret & Yann Parc

  2. Department of Surgical Intensive Care, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 75012, Paris, France

    Thomas Lescot

  3. Department of Colorectal Surgery, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

    Ben Creavin

Authors
  1. Thierry Bensignor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jérémie H. Lefevre
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ben Creavin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Najim Chafai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Lescot
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thévy Hor
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Clotilde Debove
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. François Paye
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Pierre Balladur
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Emmanuel Tiret
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yann Parc
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

TB, NC, TL, TH and CD collected data. TB, JHL, FP, PB, ET and YP interpreted the data. TN, JHL and BC analyzed the data. TB, JHL, BC and YP drafted the manuscript. NC, TL, TH, CD, FP, PB and ET revised the manuscript. All authors finally approved this manuscript. All authors are accountable for all aspects of the work.

Corresponding author

Correspondence to Jérémie H. Lefevre.

Ethics declarations

Conflict of interest

The authors declare that they have no Conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bensignor, T., Lefevre, J.H., Creavin, B. et al. Postoperative Peritonitis After Digestive Tract Surgery: Surgical Management and Risk Factors for Morbidity and Mortality, a Cohort of 191 Patients. World J Surg 42, 3589–3598 (2018). https://doi.org/10.1007/s00268-018-4687-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-018-4687-6

Search

Navigation