Scheduled reoperations (etappenlavage) for diffuse peritonitis
W. Teichmann, D. H. Wittmann and P. A. Andreone
Etappenlavage, a new concept of scheduled multiple laparotomies with
abdominal lavage for diffuse peritonitis, has been in use since 1979. The
purpose of etappenlavage is to ensure exclusion of the infected source,
promote maximal elimination of toxic necrotic material, and allow prompt
recognition of complications to effect immediate repair. Patients with
diffuse peritonitis at high risk of developing multiple system organ
failure (as assessed by high scores in the Peritonitis Index Altona and
Acute Physiology and Chronic Health Evaluation classifications) were
routinely reexplored on a daily basis until evidence of improvement or
healing was noted. From 1980 to 1984, 61 patients with intra-abdominal
sepsis were treated. Thirty-four cases were due to spontaneous perforation
of an intestinal viscus, and 27 cases were secondary to postoperative
infections. In 51 cases the primary process was present for more than 48
hours. A total of 235 etappenlavages were performed (mean, 3.9 per
patient). In ten cases, additional bowel lacerations were noted and
repaired at the second laparotomy. In the last 31 patients, closure with a
zipper has facilitated reoperation. No drains were used. After definitive
closure, primary wound healing was seen in 79% of cases. The overall
mortality in this high-risk group was 22.9%.
