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A Surgical Strategy

Philip L. Glick, MD; Carlos A. Pellegrini, MD; Stephanie Stein, MD; Lawrence W. Way, MD

Arch Surg. 1983;118(5):646-650.

Abstract
• To reassess the role of laparotomy and extraserosal drainage in the treatment of patients with abdominal abscess, we analyzed the course of 79 patients who underwent 97 operations to treat 120 abdominal abscesses during a five-year period. In 66 clinical episodes the abscess was drained by the most direct approach. Sepsis resolved with a single operation in 80% of these patients, five patients (8%) required a second operation for drainage for an abscess, and eight patients (12%) died. In 31 clinical episodes, the abscess was drained by a laparotomy. Sepsis resolved with a single operation in 61% of these patients, seven patients (21%) had a second abscess, six patients (19%) required a second operation to drain a metachronous abscess, and six patients (19%) died. When the location or number of abscesses was diagnosed incorrectly, the success rate of therapy fell substantially. Since most abdominal abscesses can now be accurately diagnosed preoperatively, most abscesses should be drained by a direct approach. Exploratory laparotomy is indicated when preoperative localization is unsuccessful, when sepsis has not resolved after other methods of drainage, or when the patient has a concomitant abdominal condition that must be treated surgically.

(Arch Surg 1983;118:646-650)

Author Affiliations
From the Surgical Service, Veterans Administration Medical Center (Drs Pellegrini and Way), and the Department of Surgery, University of California, San Francisco (Drs Glick, Pellegrini, Stein, and Way).

Footnotes
Accepted for publication Jan 28, 1983.

Read before the 90th annual meeting of the Western Surgical Association, Kansas City, Mo, Nov 17, 1982.

Reprint requests to Surgical Service (112), Veterans Administration Medical Center, 4150 Clement St, San Francisco, CA 94121 (Dr Pellegrini).

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