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Reduced preoperative serum choline esterase levels and fecal peritoneal contamination as potential predictors for the leakage of intestinal sutures after source control in secondary peritonitis.

Authors :
Amati AL
Ebert R
Maier L
Panah AK
Schwandner T
Sander M
Reichert M
Grau V
Petzoldt S
Hecker A
Source :
World journal of emergency surgery : WJES [World J Emerg Surg] 2024 Jun 05; Vol. 19 (1), pp. 21. Date of Electronic Publication: 2024 Jun 05.
Publication Year :
2024

Abstract

Background: The high rate of stoma placement during emergency laparotomy for secondary peritonitis is a paradigm in need of change in the current fast-track surgical setting. Despite growing evidence for the feasibility of primary bowel reconstruction in a peritonitic environment, little data substantiate a surgeons' choice between a stoma and an anastomosis. The aim of this retrospective analysis is to identify pre- and intraoperative parameters that predict the leakage risk for enteric sutures placed during source control surgery (SCS) for secondary peritonitis.<br />Methods: Between January 2014 and December 2020, 497 patients underwent SCS for secondary peritonitis, of whom 187 received a primary reconstruction of the lower gastro-intestinal tract without a diverting stoma. In 47 (25.1%) patients postoperative leakage of the enteric sutures was directly confirmed during revision surgery or by computed tomography. Quantifiable predictors of intestinal suture outcome were detected by multivariate analysis.<br />Results: Length of intensive care, in-hospital mortality and failure of release to the initial home environment were significantly higher in patients with enteric suture leakage following SCS compared to patients with intact anastomoses (p < 0.0001, p = 0.0026 and p =0.0009, respectively). Reduced serum choline esterase (sCHE) levels and a high extent of peritonitis were identified as independent risk factors for insufficiency of enteric sutures placed during emergency laparotomy.<br />Conclusions: A preoperative sCHE < 4.5 kU/L and generalized fecal peritonitis associate with a significantly higher incidence of enteric suture insufficiency after primary reconstruction of the lower gastro-intestinal tract in a peritonitic abdomen. These parameters may guide surgeons when choosing the optimal surgical procedure in the emergency setting.<br /> (© 2024. The Author(s).)

Details

Language :
English
ISSN :
1749-7922
Volume :
19
Issue :
1
Database :
MEDLINE
Journal :
World journal of emergency surgery : WJES
Publication Type :
Academic Journal
Accession number :
38840189
Full Text :
https://doi.org/10.1186/s13017-024-00550-x