Concerning Determination of Indications for Staging Abdominal Cavity Sanitation at the Extentive Purelent Peritonitis

The purpose of the study To assess advisability of staging abdominal cavity sanitation and multimodality therapy efficiency of extensive purulent peritonitis patients with compensated multiple organ dysfunction. Materials and methods Prospective results estimation of therapy 438 extensive purulent peritonitis patients with multisystem disorders is represented in work. The base of individual care was operative intervention, including nidus peritonitis eradication, nasogastricintestinal intubation and peritoneal lavage within the set of staging procedures, which were carried out by video laparoscopic method. The efficiency of remedial measures was assessed with the help of physical, clinical laboratory, biochemical and special diagnostic techniques (bacteriological, gas-liquid chromatography, computer phonoenterography, cystomanometry). Results and their discussion In the course of therapy of extensive purulent peritonitis at the stage of compensated multiple organ dysfunction, the main problems were connected with the solution of a question concerning necessity of staging sanitations. For this purpose, intraoperative assessment of abdominal membrane lesion was taken into consideration. In the event that abdominal cavity index was in “blind” interval from 10 to 13 scores (indications of occasional sanitation can be interpreted as doubtful), dynamics of volatile fatty acids in biological objects took on special significance. Tendency to rising the level of acetic, propionic and butyric acids in blood, and also “stagnation” of its quantity in peritoneal exudates at the level of 0,150±0,004; 0,00012±0,00002; 0,00008 ±0,00001 mmol/L respectively, indicated on after sensation of ill being in abdomen. Accordingly, twenty four hours later, after original surgery video laparoscopy was carried out for 28 patients. For 9 of them full endoscopic sanitation was carried out in the connection with identifications of signs protract peritonitis. For the rest patients, the totality of received information allowed to give up peritoneal lavage. Conclusion At therapy organization of patients with extensive purulent peritonitis in the stage of compensation multiple organ dysfunction for determination of indications to staging abdominal cavity, the role of “secondary endpoint” can implement the assessment of changes volatile fatty acids content in blood and peritoneal exudates during 24-28 hours after the original surgery.Video laparoscopic technique of staging sanitation among the most of patients allows to lower intervention traumatism up to the level of diagnostic test. Evaluating it, the lethality at the level of 0, 5% as a whole proves the accuracy of chosen method of such patients’ management.

Peritonitis, multiple organ dysfunction, therapy