Methodology for assessing the severity of diffuse peritonitis and prognosis of relaparotomy

Abstract

INTRODUCTION. The problem of treating patients with peritonitis has always been and still remains relevant in surgery. Moreover, aspects of treating patients with tertiary peritonitis requiring repeated interventions are of particular importance. The OBJECTIVE of this work was to develop and evaluate the clinical effectiveness of a score-prognostic scale that allows to identify groups of patients with a high risk of persistent surgical infection in the abdominal cavity, in which a single intervention cannot be considered effective even despite the elimination of the primary surgical infection focus.METHODS AND MATERIALS. To achieve the goal, a correlation was evaluated between a number of factors and the likelihood of relaparotomy in a retrospective group consisting of 111 patients with secondary peritonitis. Based on the achieved data, score-prognostic scale for assessing the severity of peritonitis was developed, which allowed to formulate an algorithm of surgical tactics, which was used in the treatment of 109 patients. A group of 34 people with a high risk of tertiary peritonitis development was allocated from the number of patients – of which 20 patients had a total number of 39 planned surgical interventions.RESULTS. The use of the developed scale led to an increase in the total number of surgical interventions, however, reducing postoperative mortality by 1.7 times (p = 0.001) mainly due to improved survival rates in the group of patients with severe forms of peritonitis.CONCLUSION. The obtained results allowed to recommend the developed integral prognostic scale for assessing the severity of peritonitis for use in clinical practice.

Keywords

• diffuse peritonitis
• relaparotomy
• laparostoma
• surgical infection of the abdominal cavity
• program sanitation
• prognostic scale