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Clinical Significance of the Combination of Intraoperative Lavage and Continuous Antibiotic Peritoneal Lavage in Patients with Peritonitis

Y. Yovchev, G. Minkov, E. Dimitrov, A. Petrov, St. nikolov, E. Enchev, f. Hadjipetkov, t. Vlaykova

Abstract


Background and Aim: The aim of our study is to determine the clinical significance of a combination of intraoperative and postoperative continuous closed lavage with antibiotic (PCLA) in patients with severe peritonitis.Materials and Methods: We analyzed 187 patients with severe peritonitis for a period of 10 years – 89 (47.6%) with total and 98 (52.4%) with diffuse peritonitis. All included patients were with clinical signs of sepsis and ICU treatment was needed. We performed peritoneal lavage during the surgical intervention in all patients, but PCLA was used in 98 (52.4%) of the patients. In all patients, we observed: amount of fluid, need of relaparotomy, duration of systemic antibiotic application and mortality. Results: We found significant statistical association between morbidity, mortality, and the amount of fluid, used for intraoperative and PCLA – patients who needed volume over 4 liters for intraoperative lavage were with high morbidity and mortality (p-0.0001; p-0.003, respectively) and PCLA with volume under 4 l was related to lower rate of complications and better outcome (p-0.0056). The mean duration of systemic antibiotical application in patients with PCLA was 7.45 days ± 2.61 against 12.6 days ± 3.5 without lavage (p-0.0093). The rate of relaparotomy was lower in patients with PCLA (p-0.0029). The mortality in the study reached 8.02% (n-15). Four of the 15 patients (26.6%) with unfavorable outcome were treated with PCLA (p-0.002). Independent predictors of mortality were: volume for lavage over 4 l (p-0.000), relaparotomy (p-0.002), need for PCLA over 72 hours (p-0.006). Conclusion: The application of PCLA is an effective therapeutic option for reduction of the relaparotomy rate and mortality in complicated patients with severe peritonitis.

Keywords

Keywords: peritonitis, intraperitoneal lavage, antibiotic, relaparotomy




DOI: http://dx.doi.org/10.14748/ssm.v48i0.2288

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About The Authors

Y. Yovchev

G. Minkov

E. Dimitrov

A. Petrov

St. nikolov

E. Enchev

f. Hadjipetkov

t. Vlaykova

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