Abstract:
:Some patients are prone to persisting intraabdominal infection regardless of initial eradication of the source of infection. Our aim was to characterize patients who had to undergo relaparotomy for persisting abdominal sepsis using simple clinical parameters and to define those patients who are susceptible to benefit of aggressive surgical treatment by early and repeated reoperations to control multiple organ dysfunction syndrome (MODS) caused by ongoing intraabdominal infection. Persisting abdominal sepsis was the cause of death in all of our patients who had to undergo relaparotomy. Controlling persisting abdominal sepsis should achieve a reduction in the tremendously high mortality rate. Performing a case-control study, we retrospectively reviewed 523 consecutive patients with secondary peritonitis treated from 1986 to 1996 and focused our attention on 105 patients, in whom standard surgical treatment of secondary peritonitis failed and who had to undergo relaparotomy for persisting abdominal sepsis (study group). Overall, there was no significant difference in the postoperative mortality rate between "planned relaparotomy" and "relaparotomy on demand" (54.5% versus 50. 6%). Equally clear risk estimations were given preoperatively by both the Acute Physiology and Chronic Health Evaluation (APACHE) II and the Goris scores. There was a significant difference between patients of the control group and patients of the study group with regard to preoperative APACHE II score, Goris score, age >70 years, albumin <30 g/L, extent of peritonitis, and outcome (p = 0.0001). Reexploration performed more than 48 hr after the initial operation resulted in a significantly higher mortality rate (76.5% versus 28%; p = 0.0001). However, the time of reoperation had no significant impact on survival in patients with an APACHE II score of > or = 26, because physiologic derangement is such that only a few patients could benefit from reoperation. The lowest mortality rate (9%) was achieved in patients who underwent reoperation on demand within 48 hr. We conclude that patients >70 years of age with secondary peritonitis extending over the entire abdomen and a greater degree of physiologic compromise (serum albumin levels <30 g/L, preoperative APACHE II scores >20, and existing organ failure measured by the Goris score) are at high risk for developing persistent intraabdominal infection. Our data show that timely relaparotomy provides the only surgical option that significantly improves outcome. However, aggressive surgical treatment has reached its limit in patients whose source of infection could not be controlled at the initial operation. To improve overall survival the decision to perform a relaparotomy on demand after an initially successful eradication of the source of infection must be made within 48 hr, at least before MODS emerges.
journal_name
World J Surgjournal_title
World journal of surgeryauthors
Koperna T,Schulz Fdoi
10.1007/s002689910007keywords:
subject
Has Abstractpub_date
2000-01-01 00:00:00pages
32-7issue
1eissn
0364-2313issn
1432-2323pii
10.1007/s002689910007journal_volume
24pub_type
杂志文章abstract:BACKGROUND:In gastric cancer, the recurrence rate is high even after curative surgery. A relevant issue is the identification of independent prognostic factors to select high-risk patients; such features can be used as predictive factors for tailored therapies. In this study we have investigated the role of epidermal g...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-007-9016-4
更新日期:2007-07-01 00:00:00
abstract:BACKGROUND:Early mortality in ruptured abdominal aneurysm (rAAA) is high, but data on long-term outcome are scarce. The aim of this study was to investigate the long-term outcome in survivors after open surgery for rAAA in well-defined population. METHODS:This is a population-based, observational long-term follow-up (...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-020-05457-7
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:The clinical importance of papillary thyroid microcarcinoma (PTMC) remains controversial, with current guidelines suggesting that thyroid lobectomy alone is sufficient. The purpose of this study was to identify population-level treatment patterns in the USA for PTMC. METHODS:Patients with PTMC in SEER (1998...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-014-2602-3
更新日期:2014-09-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to investigate the feasibility of digital defog technique in 3D laparoscopic surgery for right colon cancer. METHODS:Fifty patients with right colon cancer were divided into digital defogging group and control group. The intraoperative image clarity, the surgeon's anxiety, the time ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-017-4402-z
更新日期:2018-06-01 00:00:00
abstract:BACKGROUND:Abdominal compartment syndrome (ACS) is a difficult entity with two main problems during its course: (1) survival of the patient during the early period and (2) closure of the open wounds during the late period. In this study we evaluated the decision to decompress according to the level of intraabdominal pr...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-007-9286-x
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:Accurate presurgical assessment is important to anticipate postoperative complications, especially in the growing proportion of elderly cancer patients. We designed a study to define which comorbid conditions at the time of diagnosis predict complications after surgery for colorectal cancer. PATIENTS:A rand...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-005-0711-8
更新日期:2007-01-01 00:00:00
abstract:BACKGROUND:Increasing numbers of patients are treated by robotic distal gastrectomy (RDG); however, it remains unclear whether RDG is clinically comparable with conventional laparoscopic distal gastrectomy (LDG). This study aimed to clarify the feasibility of RDG from safety aspects. METHODS:The study included 109 cT1...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-017-4345-4
更新日期:2018-06-01 00:00:00
abstract:OBJECTIVE:The venous vascular anatomy of the caudate lobe is exceptional. The purpose of this study was to assess portal inflow and venous outflow volumes of the caudate lobe. METHODS:Extrahepatic (provided by the first-order branches) versus intrahepatic (provided by the second- to third-order branches) portal inflow...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-016-3791-8
更新日期:2017-03-01 00:00:00
abstract:BACKGROUND:Obesity and rapid weight loss after bariatric surgery are risk factors for gallstone disease. OBJECTIVES:The present study sought to evaluate the feasibility of selective concomitant cholecystectomy only in patients with symptomatic disease and study risk factors for the development of symptomatic gallstone...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-016-3639-2
更新日期:2016-12-01 00:00:00
abstract::The release of the neuronal protein S-100B into the circulation has been suggested as an early indication of cellular brain damage. The objective of this prospective pilot study was to determine S-100B serum levels in patients undergoing cross-clamping during carotid endarterectomy (CEA) and to correlate the results w...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-002-6547-6
更新日期:2002-10-01 00:00:00
abstract:BACKGROUND:Frequent use of computed tomography (CT) in trauma patients results in frequent detection of non-trauma-related incidental findings (IFs). Inpatient documentation and disclosure at discharge are infrequent, even when they are potentially serious. We aimed to not only identify the incidence of IFs but also to...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-013-2092-8
更新日期:2013-09-01 00:00:00
abstract::The effects of pneumoperitoneum on the lower esophageal sphincter (LES) were evaluated during laparoscopic operation for esophageal achalasia. Intraoperative manometry was performed in three patients who underwent laparoscopic cardiomyectomy with Dor's fundoplication and five patients who underwent laparoscopic cholec...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s002689900146
更新日期:1996-10-01 00:00:00
abstract:BACKGROUND:It is generally believed that the accompanying conditions in patients with inflammatory bowel disease (IBD) are associated with a high incidence of surgical site infection (SSI), and sometimes these patients are classified as compromised hosts without definitive clinical evidence. The aim of this study was t...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-009-9934-4
更新日期:2009-05-01 00:00:00
abstract:INTRODUCTION:In recent years, surgical providers and advocates have engaged in a growing effort to establish metrics to estimate capacity for surgical services as well the burden of surgical diseases in resource-limited settings. The burden of disease (BoD) studies have established the disability-adjusted life year (DA...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-013-2182-7
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:The appropriate surgical approach for hepatocellular carcinoma (HCC) patients of Child-Pugh class B is unclear. The aim of this study was to clarify the prognostic factors after hepatectomy in Child-Pugh class B patients and to delineate the selection criteria for hepatectomy. METHODS:One hundred fifty pati...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-010-0929-y
更新日期:2011-04-01 00:00:00
abstract:BACKGROUND:Despite wide acknowledgement of the importance of sarcopenia and prognostic markers such as the neutrophil-to-lymphocyte ratio, the impact on cancer patient survival of the timing of sarcopenia's emergence and its severity is not well understood, nor is the association between sarcopenia and prognostic marke...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-019-05344-w
更新日期:2020-05-01 00:00:00
abstract::In an attempt to prevent the sequelae of conventional gastrectomy, such as rapid gastric emptying, dumping syndrome, intestinal content reflux, indigestion, and poor absorption, we have devised the pylorus and pyloric vagus preserving gastrectomy (PPVPG). Experimenting on 48 dogs, we found theoretic grounds for using ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/BF01655114
更新日期:1993-07-01 00:00:00
abstract::There are many concepts of risk and prognostic factor analysis for differentiated thyroid cancer. The prognostic role of lymph node metastases in follicular thyroid cancer (FTC), however, is still controversial. We performed a retrospective trial in 186 patients with FTC (124 women, 62 men; mean follow-up 5.5 years) q...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-002-6668-y
更新日期:2002-08-01 00:00:00
abstract:BACKGROUND:Complications are important indicators of immediate postoperative outcomes. The Clavien-Dindo classification (CDC) is a widely used index for the classification of surgical complications. More recently, the comprehensive complication index (CCI) has also been introduced for classifying postoperative complica...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-020-05859-7
更新日期:2021-03-01 00:00:00
abstract:BACKGROUND:Up to 50% of patients in intensive care units develop intraabdominal hypertension (IAH) in the course of medical treatment. If not detected on time and treated adequately, IAH may develop into an abdominal compartment syndrome (ACS) which is associated with a high mortality rate. Patients undergoing cardiac ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-020-05917-0
更新日期:2021-01-22 00:00:00
abstract::We conducted a prospective case series study to investigate the causes of and factors influencing morbidity and mortality in 102 consecutive patients after elective infrarenal abdominal aneurysm (AAA) surgery between 1992 and 1995. Preoperative factors (demographics, risk factor indexes, electrocardiographic findings,...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s002689900382
更新日期:1998-03-01 00:00:00
abstract:BACKGROUND:The recent development and spread of ultrasonography and ultrasonography-guided fine needle aspiration biopsy (FNAB) has facilitated the detection of small papillary microcarcinomas of the thyroid measuring 1 cm or less (PMC). The marked difference in prevalence between clinical thyroid carcinoma and PMC det...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-009-0303-0
更新日期:2010-01-01 00:00:00
abstract::A mathematic model is created to determine the economic cost per year of anticipated prolongation of life that would result from a program of abdominal ultrasonographic (US) screening for abdominal aortic aneurysm. The protocol involves US screening at age 60, 67, and 74 years with additional annual follow-up US and e...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/BF01659032
更新日期:1989-05-01 00:00:00
abstract:BACKGROUND:Transient postthyroidectomy hypocalcemia occurs in up to 30% of patients. We evaluated the effect of vitamin D deficiency on postthyroidectomy hypocalcemia. METHODS:Data were collected prospectively between January 2006 and March 2009. A total of 166 consecutive total thyroidectomies were analyzed regarding...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-010-0872-y
更新日期:2011-02-01 00:00:00
abstract:BACKGROUND:Few guidelines exist for the initial management of wounds in disaster settings. As wounds sustained are often contaminated, there is a high risk of further complications from infection, both local and systemic. Healthcare workers with little to no surgical training often provide early wound care, and where r...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s00268-014-2663-3
更新日期:2015-04-01 00:00:00
abstract::The primal need for nutrients is satisfied by mechanisms for sensing internal stores and detecting food; ATP is the most primitive signal. With increasing density of sensory neurons and glia (the primordial brain) and the emergence of autonomic neural activity throughout the endoderm, transmitters and other signaling ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-009-0138-8
更新日期:2009-10-01 00:00:00
abstract::Variceal bleeding remains an important complication in extrahepatic portal vein thrombosis (EPVT). As for portal hypertension due to other etiologies, an elective treatment to decrease the risk of subsequent rebleeding is warranted. The results of the Sugiura-Futagawa procedure (SP) in 38 patients with variceal bleedi...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/BF00294409
更新日期:1994-03-01 00:00:00
abstract:BACKGROUND:Parathyroid cancer is rare. Differentiating parathyroid carcinoma from degenerative changes at histopathology can be difficult and studies investigating the value of single immunohistochemical markers have had variable results. In this study we aimed to investigate whether a panel of immunohistochemistry mar...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-014-2700-2
更新日期:2014-11-01 00:00:00
abstract::The phrase "outcomes studies" is usually used to describe those studies where outcome is assessed in large cohorts of patients, often using data from administrative databases. They are used to determine the role and impact of variations in the structure and process of health care delivery play in routine practice. Opt...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s002689900651
更新日期:1999-12-01 00:00:00
abstract:BACKGROUND:LLR is widely adapted for HCC, while LLR in PS segments is still challenging. With recent improvement of techniques and accumulation of experiences, LLR in PS segments is feasible, but studies investigating the result after the modifications are lacking. METHODS:In this single-center, retrospective study, 1...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-020-05912-5
更新日期:2021-01-13 00:00:00