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CHARAN TEJASVI
        ML-608
The goals of operative treatment of peritonitis

I.  to eliminate the source of contamination,
II. to reduce the bacterial inoculum,
III.to prevent recurrent or persistent sepsis
 Begin broad-spectrum, systemic antibiotic therapy
  as soon as intra-abdominal infection is suspected.
 Correct existing serum electrolyte disturbances

  and coagulation abnormalities.
 Adequate analgesia with parenteral narcotic

  agents.
  Intubation and ventilator support 
 Laparatomy
 Intra and post operative drainage
 Decompression of small intestine
 Gastric emptying.
 During the surgery probe should be in stomach all

  the time, during the preoperative period, and for
  some time afterwards. Before the resumption of
  intestinal motility.
   Goal of the open-abdomen technique is to provide
    easy, direct access to the affected area.
   Done for initial damage control in extensive peritonitis.
   In patients who are at high risk for the development of
    abdominal compartment syndrome).
   Goal of the closed-abdomen technique is to provide
    definitive surgical treatment at the initial operation.
    Perform primary fascial closure and perform repeat
    laparotomy only when clinically indicated
   Staging may be performed as a scheduled second-look
    operation or through open management, with or
    without temporary closure (eg, mesh, vacuum- assisted
    closure [VAC] technique).
   The goal of the initial operation is to provide preliminary
    drainage and to remove necrotic tissue. The patient is
    then resuscitated and stabilized in an intensive care
    unit (ICU) setting for 24-36 hours and returned to the
    operating room for more definitive drainage and source
    control.
   Eg. If bowel ischemia, the initial operation -remove all
    devitalized bowel. The second-look operation serves to
    reevaluate for further demarcation and decision-making
    regarding reanastomosis or diversion.
   Temporary closure of the abdomen to prevent
    herniation and contamination from the outside of the
    abdominal contents by gauze and large, impermeable,
    self-adhesive membrane dressings; mesh (eg, Vicryl,
    Dexon); nonabsorbable mesh (eg, GORE-TEX,
    polypropylene), with or without zipper or Velcrolike
    closure devices; and VAC devices.[1]
   Advantages : avoidance of abdominal compartment
    syndrome (ACS) and easy access for reexploration.
   Disadvantages : disruption of respiratory mechanics
    and contamination of the abdomen with nosocomial
    pathogens.
   Washing reduces the microbial content in the
    exudate.

   Electrochemically activated solution of sodium
    chloride (0.05% sodium hypochlorite), it contains
    active chlorine and oxygen, furacillin and glucose
    solution 2.2% is used .
 held probe correction enteric environment,
  including decompression, intestinal lavage,
  enterosorption and early enteral nutrition.
 This reduces the permeability of the intestinal

  barrier to microorganisms and toxins, leads to
  early recovery of functional activity of the updating
  the gastrointestinal tract.
 2rubber tubes :
 One for antiseptic introduction.
 And other for active aspirated peritoneal fluid
   monitor all patients closely in the appropriate clinical setting for adequacy
    of volume resuscitation, resolution or persistence of sepsis, and the
    development of organ system failure

   The patient's overall condition should improve significantly and
    progressively within 24-72 hours of the initial treatment.

   All patients who are critically ill and patients receiving prolonged antibiotic
    therapy are at an increased risk for developing secondary, opportunistic
    infections (eg,Clostridium difficile colitis, fungal infections, central venous
    catheter infections, ventilator-associated pneumonia); monitor patients
    closely for signs and symptoms of these complications.

   Patients with severe abdominal infections demonstrate higher incidences
    of fascial dehiscence and incisional hernia development, requiring later
    reoperation.

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Peritonitis

  • 1. CHARAN TEJASVI ML-608
  • 2. The goals of operative treatment of peritonitis I. to eliminate the source of contamination, II. to reduce the bacterial inoculum, III.to prevent recurrent or persistent sepsis
  • 3.  Begin broad-spectrum, systemic antibiotic therapy as soon as intra-abdominal infection is suspected.  Correct existing serum electrolyte disturbances and coagulation abnormalities.  Adequate analgesia with parenteral narcotic agents.   Intubation and ventilator support 
  • 4.  Laparatomy  Intra and post operative drainage  Decompression of small intestine
  • 5.  Gastric emptying.  During the surgery probe should be in stomach all the time, during the preoperative period, and for some time afterwards. Before the resumption of intestinal motility.
  • 6. Goal of the open-abdomen technique is to provide easy, direct access to the affected area.  Done for initial damage control in extensive peritonitis.  In patients who are at high risk for the development of abdominal compartment syndrome).  Goal of the closed-abdomen technique is to provide definitive surgical treatment at the initial operation. Perform primary fascial closure and perform repeat laparotomy only when clinically indicated
  • 7. Staging may be performed as a scheduled second-look operation or through open management, with or without temporary closure (eg, mesh, vacuum- assisted closure [VAC] technique).  The goal of the initial operation is to provide preliminary drainage and to remove necrotic tissue. The patient is then resuscitated and stabilized in an intensive care unit (ICU) setting for 24-36 hours and returned to the operating room for more definitive drainage and source control.  Eg. If bowel ischemia, the initial operation -remove all devitalized bowel. The second-look operation serves to reevaluate for further demarcation and decision-making regarding reanastomosis or diversion.
  • 8. Temporary closure of the abdomen to prevent herniation and contamination from the outside of the abdominal contents by gauze and large, impermeable, self-adhesive membrane dressings; mesh (eg, Vicryl, Dexon); nonabsorbable mesh (eg, GORE-TEX, polypropylene), with or without zipper or Velcrolike closure devices; and VAC devices.[1]  Advantages : avoidance of abdominal compartment syndrome (ACS) and easy access for reexploration.  Disadvantages : disruption of respiratory mechanics and contamination of the abdomen with nosocomial pathogens.
  • 9. Washing reduces the microbial content in the exudate.  Electrochemically activated solution of sodium chloride (0.05% sodium hypochlorite), it contains active chlorine and oxygen, furacillin and glucose solution 2.2% is used .
  • 10.  held probe correction enteric environment, including decompression, intestinal lavage, enterosorption and early enteral nutrition.  This reduces the permeability of the intestinal barrier to microorganisms and toxins, leads to early recovery of functional activity of the updating the gastrointestinal tract.
  • 11.  2rubber tubes :  One for antiseptic introduction.  And other for active aspirated peritoneal fluid
  • 12. monitor all patients closely in the appropriate clinical setting for adequacy of volume resuscitation, resolution or persistence of sepsis, and the development of organ system failure  The patient's overall condition should improve significantly and progressively within 24-72 hours of the initial treatment.  All patients who are critically ill and patients receiving prolonged antibiotic therapy are at an increased risk for developing secondary, opportunistic infections (eg,Clostridium difficile colitis, fungal infections, central venous catheter infections, ventilator-associated pneumonia); monitor patients closely for signs and symptoms of these complications.  Patients with severe abdominal infections demonstrate higher incidences of fascial dehiscence and incisional hernia development, requiring later reoperation.