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An analysis of 14565 operations on organs of the abdominal cavity has shown that main causes of early relaparotomies were peritonites (47,4%), intestinal obstruction (33,3%), eventration of the abdominal organs (16,0%) and hemoperitoneum (3,3%). The highest lethality was after postoperative peritonitis (54,1%). For the recent 10 years the total lethality has become 31,6% lower due to better diagnosis and early relaparotomies.  相似文献   

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Indications for relaparotomy   总被引:2,自引:0,他引:2  
From 1980 to 1987, 10,446 patients were operated on. In 152 patients, the necessity of a repeated operative intervention arose. In 106 patients the emergency, in 42--delayed, and in 4--elective relaparotomies were performed. There were the following indications for relaparotomy: diffuse and circumscribed peritonitis (78 patients), ileus (46), eventration (11), hemorrhage (12), others (5). Diagnosis of postoperative complications requiring relaparotomy is difficult. The postoperative lethality was 26%.  相似文献   

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Early urgent relaparotomy   总被引:3,自引:0,他引:3  
We analyzed the indications for and implications of reoperation in 113 patients who required early urgent relaparotomy. Infection with intact organs was the most common indication, causing the most diagnostic difficulties, and presenting the most varied findings. Suture-line leaks and dehiscence were next in frequency. Bleeding caused the earliest relaparotomies and obstruction, the latest. In seven patients a technical error at the primary laparotomy was identified, and in 56 patients an error of some sort was presumed. High-mortality categories were identified, including the elderly, who were particularly susceptible if bleeding or after an emergency primary laparotomy. An aggressive policy of reoperation resulted in 59 survivors and seems to be the only practical approach in the treatment of these usually desperately ill patients.  相似文献   

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Early relaparotomies following operations on organs of the abdominal cavity were shown by the authors to be necessary in 1,3% of the patients operated on due to developing intraperitoneal complications. The main causes of repeated operations were: intestinal obstruction, diffuse peritonitis, intestinal eventration, limited purulent processes in the abdominal cavity and intraperitoneal bleedings. Postoperative lethality proved to be high (23,5%).  相似文献   

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BACKGROUND: Planned relaparotomy (PR) and relaparotomy on demand (ROD) are both frequently used in the treatment of secondary peritonitis. The aim of this study was to evaluate the mortality, morbidity and long-term outcome associated with PR compared with ROD in patients with secondary peritonitis admitted to a university hospital. METHOD: This retrospective study included 278 consecutive patients who underwent emergency laparotomy for secondary peritonitis between January 1994 and January 2000. Outcome was analysed based on the decision made by the surgeon during the first operation to perform either ROD (197 patients) or PR (81). RESULTS: The Acute Physiology And Chronic Health Evaluation II score was comparable in ROD and PR groups (10.8 versus 11.7; P = 0.222). The in-hospital mortality rate was significantly lower with ROD than PR (21.8 versus 36 per cent; P = 0.016). Two-year survival(s.e.) was 65.8(3.4) per cent in the ROD group and 55.5(5.5) per cent in the PR group (P = 0.031). CONCLUSION: The in-hospital and long-term survival rates were higher in patients with secondary peritonitis treated by ROD than in those with disease of comparable severity treated by PR. Choice of treatment strategy was an independent predictor of survival.  相似文献   

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The authors analyse the importance of the psychological barrier in the choice of the method of treatment in performing relaparotomy. Proceeding from the fact that the surgeon's psychological barrier is an objective factor aggravating the results of management of postoperative complications, the authors suggest that the indications for relaparotomy should be considered collectively. They believe that the second operation should be carried out by another, more experienced surgeon of the department. The surgeon who performed the first operation acts as an assistant during the relaparotomy.  相似文献   

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Statistical analysis of the clinical picture, history data, intraoperative findings and outcomes of treatment in 214 patients with generalized purulent peritonitis provided an algorithm for defining of indications for programmed relaparotomy. The algorithm allowed errors to decrease from 25.2 to 2.4% in the choice of surgical policy for peritonitis and to decrease mortality from 21.0 to 16.7%.  相似文献   

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Relaparotomy was performed in 252 of 23,232 (1.08%) patients operated upon. The most frequent cause of relaparotomy is purulent complications. These patients have immunodeficient states due to different causes (duration of the disease, old age, diabetes mellitus, toxemia, anemia, extension of the injuries, irrational administration of antibiotics). Due to it, anaerobic neclostridial infection is widely used. Its participation in the purulent process in the abdominal cavity achieves 80-90%. For prevention and treatment of purulent complications of great importance is the modern and adequate struggle against intoxication and hypoxia, correction of immunodepression, purposeful antimicrobial therapy. Problems in determination of indications for relaparotomy are emphasized and the necessity to perform it in earlier terms.  相似文献   

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Meta-analysis of relaparotomy for secondary peritonitis   总被引:5,自引:0,他引:5  
BACKGROUND: Planned relaparotomy and relaparotomy on demand are two frequently employed surgical treatment strategies for patients with abdominal sepsis. METHODS: The available literature was evaluated to compare the efficacy of both surgical treatment strategies. A systematic search for studies comparing planned and on-demand relaparotomy strategies in adult patients with secondary peritonitis was employed. Studies were reviewed independently for design features, inclusion and exclusion criteria, and outcomes. The primary outcome measure was in-hospital mortality. RESULTS: No randomized studies were found; eight observational studies with a total of 1266 patients (planned relaparotomy, 286; relaparotomy on demand, 980) met the inclusion criteria and were included in the meta-analysis. These eight studies were heterogeneous on clinical and statistical grounds (chi2= 40.7, d.f. = 7, P < 0.001). Using a random-effects approach, the combined odds ratio for in-hospital mortality was 0.70 (95 per cent confidence interval 0.27 to 1.80) in favour of the on-demand strategy. CONCLUSION: The combined results of observational studies show a statistically non-significant reduction in mortality for the on-demand relaparotomy strategy compared with the planned relaparotomy strategy when corrected for heterogeneity in a random-effects model. Owing to the non-randomized nature of the studies, the limited number of patients per study, and the heterogeneity between studies, the overall evidence generated by the eight studies was inconclusive.  相似文献   

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The authors have analyzed the results of treatment of 35 patients, in whom theylaparostoma put on. The mortality have constituted 45.7%. The attention was drawn on technical aspect of laparostomy establishment and closure, the issues of intestinal tubage and quantity of laparosanation conduction were discussed.  相似文献   

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The most frequent reason for relaparotomy is peritonitis, followed by mechanical ileus and secondary hemorrhage. The most common cause of postoperative peritonitis is insufficient anastomosis. The relative proportion of cases of localized peritonitis is increasing. Diffuse peritonitis is still treated by operation, according to instructions of Kirschner 1926, whereas localized peritonitis is more and more treated by percutaneous puncture. The prognosis of postoperative peritonitis is poor.  相似文献   

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