Stellenwert der einzeitigen chirurgischen Therapie bei diffuser Peritonitis (Relaparotomie „on demand“): eine unizentrische Analyse

Zusammenfassung

Hintergrund: Die diffuse Peritonitis ist ungeachtet moderner chirurgischer und intensivmedizinischer Therapieverfahren eine Erkrankung mit hoher Morbidität und Mortalität. Ziel dieser Arbeit war es, im eigenen Krankengut den Stellenwert der Relaparotomie „on demand“ (ROD) bei Patienten mit diffuser Peritonitis kritisch zu evaluieren. Patienten und Ergebnisse: In einer retrospektiven Untersuchung wurden die Therapieverläufe von 231 Patienten mit diffuser Peritonitis analysiert. Diese wiesen einen durchschnittlichen Mannheimer Peritonitis-Index (MPI) von 25,3 auf. Die Gesamtletalität im untersuchten Kollektiv betrug 14,3 %. Bei 214 Patienten gelang während der Indexoperation eine suffiziente Fokussanierung, sodass diese im Rahmen des ROD-Konzepts weiterbehandelt wurden. Bei 178 dieser Patienten bestand keine Notwendigkeit einer Reoperation, während 36 dieser Patienten im weiteren Verlauf relaparotomiert wurden. Die Letalität dieser beiden Subgruppen betrug 9 % (keine Relaparotomie) bzw. 27 % (Relaparotomie). Schlussfolgerung: Anhand des untersuchten Kollektivs zeigt sich, dass das Konzept der Relaparotomie „on demand“ nach effektiver Herdsanierung und entsprechender suffizienter Lavage im klinischen Alltag sinnvoll und praktikabel ist. Allerdings besteht weiterhin die dringliche Notwendigkeit, Parameter zu identifizieren, welche die Selektion von Patienten zur Relaparotomie vereinfachen.

Abstract

Background: Despite modern surgical and intensive-care concepts, diffuse peritonitis remains a major source of high morbidity and mortality. The aim of this study was to critically evaluate the value of relaparotomy on demand (ROD) for patients with diffuse peritonitis. Patients and Results: In a retrospective analysis, the clinical course of 231 patients with diffuse peritonitis was analysed. The mean Mannheim Peritonitis Index (MPI) was 25.3. Overall lethality in this cohort was 14.3 %. In 214 patients, source control was successful during the index operation, and these patients were treated according to an on-demand strategy. For 178 of these patients, there was no demand for a relaparotomy, whereas 36 of these patients required further surgical interventions. Lethality for these subgroups was 9 % (no relaparotomy) and 27 % (relaparotomy), respectively. Conclusions: This retrospective analysis confirms that an on-demand strategy is reasonable and feasible after successful source control and lavage. However, it still remains of clinical importance to identify parameters that may assist in selecting those patients who require a relaparotomy.

Schlüsselwörter

diffuse Peritonitis - Sepsis - Letalität - chirurgische Therapie - Relaparotomie on Demand

Key words

diffuse peritonitis - Sepsis - lethality - surgical therapy - relaparotomy on demand

^* Beide Autoren haben zu gleichen Teilen zum Entstehen der Arbeit beigetragen.

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