Expósito-Expósito M, Aragón-Palmero FJ, Curbelo-Pérez R, Pérez-Assef J, López-Flores MA

Language: Spanish
References: 22
Page: 31-35
PDF size: 62.73 Kb.

ABSTRACT

Objectives: Comparing the techniques of open abdomen (AA) and programmed relaparotomies (RP) utilized in the treatment of the patient with acute peritonitis at our hospital center. Material and methods: We carried out a retrospective study to included 60 patients with acute peritonitis over a period of 8 years. The presence of diffuse peritonitis on site and an old APACHE II score of 15 was considered acute. At first to 25 patients (1994-1998) we applied the used open abdomen (AA) technique and 35 residual patients (1999-2000) were used for the method of programmed relaparotomy (RP). To prove whether the difference of mortality between patients subjected to one or another method was significant, chi test was utilized Mann-Whitney test was used to attemp to demonstrate statistic ally significant differences in mortality when we divided and then compared subgroups of patients with apparently the same probability of dying. We carried out an analysis of regression logistics to distribute diagnostic variables for the influence of prognosis factors of mortality. Results: The group of AA remained constituted of 25 patients with an average age of 46 years and with an APACHE II score of 20.63 ± 3.24. The group of the programmed relaparotomies (RP) was conformed of 35 patients whose average age was 52 years and APACHE II score, 22.85 ± 5.68. Intestinal fistula was observed in three patients (12%) of the AA group and the abdominal compartment syndrome in two patient (5.7%) of the RP group. Five (20%) abdominal wall hernias were found in patients of the AA group, while only one patient in the RP group (2.8%) had a hernia. There were not significant differences in mortality between both groups when we worked with chi-square (P = 0.822) test; however, when we divided patients into subgroups and according to APACHE II score and worked with Mann-Whitney test, statistic ally significant differences were observed between both groups utilizing mortality as variable of grouping. In regression logistics analysis it was observed that prediction factors of mortality were: APACHE II ≥ 18, presence of SDOM, presence of postoperatory complications, existence of associate illness, and treatment with open abdomen. Discussion: We found significant differences between both groups utilizing mortality as variable of grouping. We think that early diagnosis of intraabdominal sepsis continues as the fundamental beginning to diminish mortality of the patients with acute peritonitis independent of the surgical technique utilized, the capacity of the administered antibiotics, and the solvency of support care.

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