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Surgical attitude above the focus of postoperative peritonitis on dependency of its localization in peritoneal cavity


Author: Valeriu Bogdan
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2007
Scientific adviser: Vladimir Hotineanu
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 25 April, 2007
Approved by NCAA on the 14 June, 2007

Abstract

Adobe PDF document0.62 Mb / in romanian

Thesis

CZU 616.381-002-02:616-089.168-06-031.13-089

Adobe PDF document 1.62 Mb / in romanian
148 pages


Keywords

postoperative peritonitis, programmed relaparotomies, laparostomy, bursoomentostomy, duodenostomy, antrumduodenostomy

Summary

The aim of the study was the improving of the results of the surgical treatment by using different medical tactics and optimal surgical techniques above the focus of postoperative peritonitis in peritoneal cavity.

The study is based on the analysis of surgical treatment via continued “staged” method applied to the group of 306 patients with postoperative peritonitis, observed in surgical clinic nr.1, 2nd Chair of Surgery, State Medical University during the 1991-2006 period.

On dependency of the peritonitis removing operative possibilities, the entire number of the patients was divided into 3 basic groups: with focus localized in supramesocolic region - 137 (44,77%) cases, middle abdominal region- 132 (43,14%) cases and in pelvic region - 37 (12,09%) cases.

Thus, it was established that removing of the peritonitis cause in supramesocolic region practically was impossible to perform.

In the middle abdominal region the optimal are methods of radical elimination of the focus of peritonitis. In cases of higher fistulas of the small intestine by means of: a) resection with primary anastomosis and nasointestinal decompression, and b) resection with primary anastomosis or suturing of fistula, with forming of terminal ileostomy on the distance, and in cases of low non-formed intestinal fistulas the methods of management via resection with forming ileo- or colostomy.

The optimal methods for pelvic region consists in excluding via applyng terminal ostomy proximally a fistula and limitation by means of an active drainage and a local lavage with the goal to create a controlled fistula.

Our study specified and concretized the indications for continued „staged” methods of postoperative peritonitis treatment and established the criteria for its finalization and the optimal terms of peritoneal cavity closure.

Individual curative attitude regarding the postoperative peritonitis focus, the application of different and optimal surgical tactics and techniques on dependency of peritoneal localisation, the combination with continued „staged” treatment, permitted us to improve the efficacy of curative results and to decrease postoperative lethality of the pacients up to 23,36% in of supramesocolic region of the abdominal cavity cases, to 19,70% cases for middle abdominal region and 18,91%cases for the inferior region.