Does a Second‐look Operation Improve Survival in Patients with Peritonitis due to Acute Mesenteric Ischemia? A Five‐year Retrospective Experience

Second‐look laparotomy is one of the mainstays of surgical treatment of acute mesenteric ischemia (AMI). The aim of this study was to analyze its role in the survival of patients with infarcted gangrenous bowel resulting from AMI. A retrospective chart review of all patients admitted over the study...

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Bibliographic Details
Published in:World journal of surgery 2005-05, Vol.29 (5), p.645-648
Main Authors: Kaminsky, Oleg, Yampolski, Igal, Aranovich, David, Gnessin, Ehud, Greif, Franklin
Format: Article
Language:English
Subjects:
Abdomen
Acute Disease
Acute Mesenteric Ischemia
Biological and medical sciences
Bowel Necrosis
Comorbidity
Experienced Surgeon
Female
Gastroenterology. Liver. Pancreas. Abdomen
General aspects
Humans
Laparotomy
Male
Medical sciences
Mesenteric Vascular Occlusion - complications
Mesenteric Vascular Occlusion - surgery
Necrotic Bowel
Other diseases. Semiology
Peritonitis - etiology
Peritonitis - mortality
Retrospective Studies
Second-Look Surgery
Selective Approach
Treatment Outcome
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Summary:Second‐look laparotomy is one of the mainstays of surgical treatment of acute mesenteric ischemia (AMI). The aim of this study was to analyze its role in the survival of patients with infarcted gangrenous bowel resulting from AMI. A retrospective chart review of all patients admitted over the study period was undertaken. The study population consisted of 41 patients with clinical evidence of peritonitis and gangrenous, perforated bowel on surgical exploration. Outcome was compared among patients who underwent second‐look laparotomy and those who did not. Fifteen patients with an American Society of Anesthesiologists (ASA) score of less than 4 underwent second‐look laparotomy. Six patients had residual necrotic bowel that required additional resection. Only one (17%) of them survived. Of the nine remaining patients, who had no evidence of necrosis, only two survived (22%). Overall survival in this group was 20%. Twenty‐six patients were managed without second‐look laparotomy. Nine of them, with an ASA score of 4–5, died soon after the operation. The decision not to operate on the remaining 17 patients with an ASA score
ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-005-7380-5