The Open Packing -- Laparostomy --: In Pancreatitis and Peritonitis

ISBN-13: 9783540522768 / Angielski / Miękka / 1991 / 324 str.

Hans-Werner Waclawiczek; Oskar Boeckl; Gernot Pauser

Opis

The continued high mortality (up to 70 %) in patients with necro tizing pancreatitis and diffuse peritonitis has led to the develop ment of various surgical strategies within the past few decades. Up to the present decisions about the management of these disea ses have been rather difficult because of the individual courses differ considerably, even being incomparable. Today, as a result of our in creased knowledge of the pathophysiology, the impro ved imaging procedures, and the standaridized intensive care, the rend is moving toward delayed surgical intervention. The goals in the surgical treatment of necrotizing pancreatitis and diffuse peritonitis are still surgical removal of the focus of infection, elimination of endotoxins by lavage, and optimal drainage of the peritoneal cavity. Depending on the patient's general condition this cannot always be achieved in the first surgi cal intervention. A number of surgical methods have therefore been developed, such as postoperative dorsoventral lavage, step by-step lavage therapy, postoperative closed continuous perito neal lavage, and open treatment (laparostomy). The last-mentioned method ist not new; it was first described by KOR'J;E in 1894 for the treatment of necrotizing pancreatitis. However, due to the progress in intensive care medicine (long term respiratory therapy, hemofiltration, etc.) in the last few years this method of management has become successful and gai ned in recognition."

Spis treści

I. Abdominal Sepsis.- 1. Pathology.- Pathology of Sepsis and Its Effects on the Pancreas.- Effects of Sepsis on the Lung.- Effects of Sepsis on the Liver.- Hygienic Management Following Laparostomy.- 2. Treatment.- Treatment of Respiratory Disorders.- Peritonitis and Intraabdominal Abscesses.- Parenteral and Enteral Nutrition in Sepsis.- New Concepts in Fluid Therapy for Patients with Intraabdominal Infection.- Pancreatitis and Blood Coagulation.- The Effect of Norepinephrine on Hemodynamics in Extreme High Output — Low Resistance State in Peritonitis and Pancreatitis.- Endotoxemia Fails to Predict Survival in Severe Intraabdominal Infection.- II. Pancreatitis.- 1. Open Packing.- The Role of Open Packing in the Management of Infected Pancreatic Necrosis.- Interdisciplinary Management in Necrotizing Pancreatitis.- Laparostomies and Preplanned Revisions: A Therapeutic Concept in Acute Necrotizing Pancreatitis.- The Extraperitoneal Compartment — Surgical Approach to Necrotizing Pancreatitis.- Benefit and Limitations of Open Packing Laparostomy in Acute Pancreatitis.- Surgical Therapy of Necrotizing Pancreatitis by Open Packing Laparostomy.- Value of Open Packing in the Treatment of Necrotizing Pancreatitis.- Total Necrosis of the Pancreas with Peripancreatic Necrosis — An absolute Indication for Laparostomy?.- 2. Alternative Procedures.- Acute Necrotizing Pancreatitis: Surgical Management with Capillary Drainage, Long-term Lavage and Continuous Enteral Nutrition.- Necrosectomy and Continuous Closed Bursa Lavage in Necrotizing Pancreatitis.- Surgery During Acute Pancreatitis — Observations in 289 Patients.- Routine Repetitive Laparotomy for Acute Necrotizing Pancreatitis.- III. Peritonitis.- 1. Open Packing.- Step-by-Step Lavage Therapy for Diffuse Peritonitis: a Clinical Report.- Intensive Therapy in the Surgical Treatment of Diffuse Peritonitis.- Open Treatment in Diffuse Suppurating Peritonitis.- Laparostomy for the Surgical Treatment of Diffuse Peritonitis.- Open Management of the Septic Abdomen Using the Plastic Bag Technique.- Open Packing in the Treatment of Perforated Sigmoid Diverticulitis.- Complications of Laparostomy in Diffuse Peritonitis.- Pitfalls and Errors in Open Packing Laparostomy.- Dressing Laparostomies with Synthetic Mesh.- 2. Alternative Procedures.- Closed Continuous Postoperative Peritoneal Lavage in Diffuse Bacterial Peritonitis.- Severe Postoperative Peritonitis: Management with One-Stage Operation and Primary Closure of the Abdomen.- Management of the Organisms and Resistance Development with Diffuse Peritonitis During Programmed Open Lavage.- Effect of the Frequency of Programmed Peritoneal Lavage on Chances of Survival with Diffuse Peritonitis.- Planned Relaparotomy in Severe Diffuse Peritonitis.

O autorze

The Open Packing is a new and efficient method for treating necrotizing pancreatitis and severe peritonitis. It can reduce significantly the complications and lethality of these diseases. Close interdisciplinary cooperation with intensive care staff is essential for good results.