Abstract
Background: Peritonitis is, even today, a significant source of death and complications. The
objective of this study was to determine the morbidity and mortality rates, the incidence
of reoperations, and the need for additional treatment strategies (on demand) in patients
with diffuse peritonitis. Methods: Prospective analysis including all patients (n = 258) with diffuse peritonitis admitted
to our surgical service between November 1993 and April 1998 who underwent a uniform
surgical treatment concept of peritonitis including early intervention, source control,
and extensive intraoperative lavage. Results: The 258 patients with diffuse peritonitis averaged a mean Mannheim Peritonitis Index
of 27.1 points (range, 11-43 points). Source control at the initial operation was
possible in 230 of the patients (89%), of those, 21 patients (9%) needed reintervention.
In 28 patients (11%), source control was not possible at the initial operation. Twenty
of these patients (71%) had to undergo additional treatment strategies (on demand)
such as continuous lavage and/or laparostomy. Overall 228 of the 258 patients (88%)
needed just 1 initial surgical intervention. The overall morbidity rate was 41%; the
rate of reoperation was 12%, and the hospital mortality rate was 14%. Conclusions: A conservative surgical treatment concept supplemented with “extensive” intraoperative
lavage reduces the reoperation rate compared with other treatment standards of peritonitis
and achieves a low mortality rate in patients with diffuse peritonitis. (Surgery 2000;127:178-84.)
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Article info
Publication history
Accepted:
July 18,
1999
Footnotes
*Reprint requests: M.W. Büchler, MD, Department of Visceral and Transplantation Surgery, University of Bern, Inselspital, CH-3010 Bern, Switzerland.
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
