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

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 sur...

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Bibliographic Details
Published in:World journal of emergency surgery 2024-06, Vol.19 (1), p.21-14, Article 21
Main Authors: Amati, A L, Ebert, R, Maier, L, Panah, A K, Schwandner, T, Sander, M, Reichert, M, Grau, V, Petzoldt, S, Hecker, A
Format: Article
Language:English
Subjects:
Aged
Analysis
Anastomotic Leak
Biomarkers - blood
Choline
Choline esterase
Emergency laparotomy
Feces
Female
Health aspects
Humans
Laparotomy - adverse effects
Laparotomy - methods
Male
Middle Aged
Mortality
Peritonitis
Peritonitis - surgery
Postoperative Complications
Retrospective Studies
Risk Factors
Secondary peritonitis
Surgeons
Suture leakage
Sutures
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Summary: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. 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. 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 
ISSN:1749-7922
1749-7922
DOI:10.1186/s13017-024-00550-x