Ulus Travma Acil Cerrahi Derg. 2009; 15(1): 52-57

Aðýr sekonder peritonitli hastalarda laparostomi

Dogan Gonullu¹, Ferda Nihat Köksoy¹, Okan Demiray¹, Sibel Gurdal Ozkan², Tayfun Yucel³, Osman Yucel^1
1Taksim Eðitim Ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ýstanbul
²Namýk Kemal Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Tekirdað
³Sakarya Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Sakarya

AMAÇ: Bu çalýþmada, sekonder peritonitli hastalarýn tedavisinde, Bogota bag ile geçici karýn kapatmanýn etkinliði ve sað kalýmdaki risk faktörleri deðerlendirildi.
GEREÇ-YÖNTEM: Sekonder peritonit nedeniyle Bogota bag kullanýlarak geçici olarak karýn kapatýlmasý uygulanan 37 hasta (22 erkek, 15 kadýn; ort. yaþ 63,5; daðýlým 44-83) ele alýndý. Hastalýðýn þiddetinin belirlenmesinde Acute Physiology and Chronic Health Evaluation II (APACHE II) ve Mannheim Peritonit Ýndeksi (MPI) skorlarý kullanýldý. APACHE II’nin sonuçlarý ve etkililiði ve MPI deðerleri, geriye dönük olarak deðerlendirildi.
BULGULAR: Mortalite oraný %43,2 olarak belirlendi. Yaþayan ve hayatýný kaybeden hastalarýn, baþvuru APACHE II (r=0,81, p=0,001) ve MPI (r=0,39, p=0,02) skorlarý ve ameliyat sayýlarý (1,6’ya karþýn 4,7 ameliyat) arasýnda yaþayanlarýn lehine anlamlý fark saptandý. Beþ hastada laparostomi primer olarak kapatýlýrken, yaþayan diðer hastalar sekonder iyileþmeye býrakýldý. SONUÇ: Sekonder peritonitli hastalarda Bogota bag ile geçici karýn kapatýlmasý, ucuz ve basit bir yöntem olup, þeffaflýðýyla altýndaki organlarýn ve enfeksiyonun gözlenmesine olanak saðlar. Yüksek APACHE II ve MPI skorlarý ve fazla sayýda relaparotomi uygulanmasý, daha yüksek mortalite oraný ile sonuçlanmaktadýr.

Anahtar Kelimeler: APACHE II, Bogota bag; karýn içi morbidite; Mannheim Peritonit Ýndeksi; mortalite; sekonder peritonit; geçici abdominal kapatma.

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Laparostomy in patients with severe secondary peritonitis

Dogan Gonullu¹, Ferda Nihat Köksoy¹, Okan Demiray¹, Sibel Gurdal Ozkan², Tayfun Yucel³, Osman Yucel^1
1Department Of General Surgery, Taksim Training And Research Hospital, Istanbul
²Department Of General Surgery, Namýk Kemal University, Faculty Of Medicine, Tekirdað
³Department Of General Surgery, Sakarya University Faculty Of Medicine, Sakarya, Turkey

BACKGROUND: The aim of this study was to evaluate the effectiveness of laparostomy with the Bogota bag for the management of patients with severe secondary peritonitis and the risk factors for survival. METHODS: Thirty-seven patients (22 males, 15 females; mean age 63.5; range 44 to 83 years) with secondary peritonitis were treated by laparostomy and temporary closure with Bogota bag. APACHE II scores and Mannheim Peritonitis Index (MPI) were used to calculate the disease severity. The outcomes and effectiveness of APACHE II and MPI values were analyzed retrospectively. RESULTS: The mortality rate was 43.2%. Significant differences were noted between survivors and non-survivors according to initial APACHE II and MPI scores and the number of operations. The non-survivors had higher APACHE II (r=0.81, p=0.001) and MPI (r=0.39, p=0.02) scores. The patients who survived were re-operated 1.6 times and those who died were re-operated 4.7 times. In five patients, laparostomy was closed primarily, while in the others, the wound was left open to heal secondarily. CONCLUSION: Patients with higher APACHE II and MPI scores and number of operations had higher rates of mortality due to their major risk factors. Temporary abdominal closure using the Bogota bag in patients with secondary peritonitis is an inexpensive-simple method, permitting evaluation of underlying viscera and recognition of infection.

Keywords: APACHE II, Bogota bag; intraabdominal morbidity; Mannheim Peritonitis Index; mortality; secondary peritonitis; temporary abdominal closure.

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