Reconstructive abdominal operations after laparostomy and multiple repeat laparotomies for severe intra-abdominal infection

Author:

Scripcariu V1,Carlson G1,Bancewicz J1,Irving M H1,Scott N A1

Affiliation:

1. University Department of Surgery, Hope Hospital, Salford, UK

Abstract

Abstract Between 1980 and 1993, 18 patients underwent formal laparotomy after laparostomy and healing of the peritoneal cavity by granulation. The majority (12 patients) were men and the median age was 47 (range 22–67) years. Intra-abdominal infection following surgery for Crohn's disease (four patients) and necrotizing pancreatitis (six) was the most common primary condition requiring laparostomy. A total of 23 reconstructive operations were carried out on the 18 patients a median of 6 (range 1–18) months after laparostomy. The indication for surgery was for closure and/or resection of an enteric fistula in 13 patients. The site of the fistula included three gastric, two duodenal, 11 small bowel and seven colonic. A further four patients required operation for closure or refashioning of a stoma. Five patients subsequently required a second laparotomy: two for elective restoration of bowel continuity, two for recurrent fistula and one for an acute abdomen. After reconstructive surgery following laparostomy 16 patients were discharged home alive and well, one requiring home parenteral nutrition for short boweksyndrome. In contrast, the two oldest patients in the series died from multiple organ failure immediately after initial reconstructive surgery. Both had pre-existing medical problems and in neither was there evidence of further intra-abdominal infection after reconstruction.

Publisher

Oxford University Press (OUP)

Subject

Surgery

Reference13 articles.

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2. On leaving the peritoneal cavity open in acute generalized suppurative peritonitis;Steinberg;Am J Surg,1979

3. Abdominal sepsis managed by leaving abdomen open;Duff;Surgery,1981

4. Open peritoneal drainage as effective treatment of advanced peritonitis;Maetani;Surgery,1981

5. Open treatment of pancreatic abscess;Bradley;Surg Gynecol Obstet,1984

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