Complications of planned relaparotomy in patients with severe general peritonitis

Objective: To analyse the complications of planned relaparotomy for severe general peritonitis and to define when to discontinue relaparotomies. Design: Retrospective study. Setting: University hospital, The Netherlands. Subjects: 24 consecutive patients who underwent planned relaparotomy for widespread faecal peritonitis caused by large bowel perforation (n = 15) or postoperative anastomotic leakage (n = 9). Interventions: 136 planned relaparotomies and 23 emergency laparotomies for intra-abdominal bleeding. Main outcome measures: Mortality, intra-abdominal complications, multiple organ failure (MOF) scores, and cultures of the abdominal cavity. Results: Seven patients died (29%). These patients had significantly higher MOF scores than survivors (p < 0.001). MOF scores did not change during the first seven days. Intra-abdominal complications were more common among those that died than survivors (p < 0.02) and correlated strongly with the number of planned relaparotomies (r = 0.90; p < 0.001). In all but three patients intra-abdominal cultures ceased to grow pathogens (<10(3) cfu/ml microorganisms) after a median of 3 relaparotomies. Patients in whom fascial closure was achieved had undergone significantly fewer relaparotomies than those in whom it was not possible (p < 0.05). Conclusion: Planned relaparotomy seems to be associated with appreciable morbidity and does not reverse organ dysfunction. The criterion of < 10(3) cfu/ml before cessation of planned relaparotomies might be useful.