Repeated resections of the small bowel and placement of new small-bowel anastomoses in the case of postoperative peritonitis
Abstract
Currently, the treatment of postoperative perforated peritonitis is an urgent problem of modern surgery. An important point is to reduce the risk of insolvency of intestinal sutures when repeated enteric anastomoses are used under these conditions.
The aim of the work is to improve the results of surgical treatment of patients with postoperative peritonitis associated with the failure of the seams of the small-bowel anastomoses through the differentiated use of new primary and delayed small-bowel anastomoses.
Material and methods. The experience of surgical treatment of 114 patients with postoperative peritonitis, arising due to insolvency of the seams of previously imposed entero-enteroanastomoses, is presented. The main criteria for the use of different surgical tactics were the severity of the patient's condition (APACHE II) and the severity of peritonitis (Mannheim Peritonitis Index – MPI). In this regard, after resection of the small-bowel in group 1 patients (n=55), primary anastomosis was used, in group 2 (n=59) delayed anastomosis was used. In an extremely serious condition, the enterostoma was removed.
Results. After resection of the small intestine with the imposition of a primary anastomosis with APACHE II 11.3±0.7 and MPI 13.7±1.3 points, the number of failure of the anastomotic sutures was observed in 6 (10.9%) patients with a mortality of 12.7% . With delayed anastomoses, in more severe patients, with APACHE II 17.5±0.8 and MPI 18.4±0.4 points, repeated insolvency of the seams of the anastomoses was noted in 9 observations (15.3%) with a mortality rate of 18.6% (p>0.05).
Conclusion. A differentiated approach to repeated anastomosis in patients with postoperative peritonitis should be based on an assessment of the severity of the patients (APACHE II) and the severity of peritonitis (MPI) with a preference for delayed small-bowel anastomosis in more severe patients, and in critical situations of removing an enterostomy.
Keywords:postoperative peritonitis, small-bowel anastomotic leak, delayed small-bowel anastomosis
Conflict of interests. The authors declare no conflict of interests.
For citation: Zharikov A.N., Lubyansky V.G., Aliev A.R. Repeated resections of the small bowel and placement of new small-bowel anastomoses in the case of postoperative peritonitis. Clin Experiment Surg. Petrovsky J. 2020; 8 (1): 22–8. doi: 10.33029/2308-1198-2020-8-1-22-28 (in Russian)
Received 23.12.2019. Accepted 05.02.2020.
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