G. Roeyen et al., SCHEDULED RELAPAROTOMIES USING A ZIPPER SYSTEM FOR THE TREATMENT OF DIFFUSE GENERALIZED PERITONITIS IN CHILDREN, Acta Chirurgica Belgica, 96(5), 1996, pp. 201-205
In the treatment of diffuse peritonitis, planned relaparotomies with p
eritoneal lavages using a zipper system (EthiZip(R) Ethicon) are somet
imes necessary to obtain a complete eradication of the infectious focu
s. While most reported series are dealing with an adult population, th
is review focuses on the treatment of peritonitis using a zipper syste
m in a paediatric age group. In a period of 3 years, insertion of a zi
pper device and peritoneal lavages were considered necessary to contro
l intraabdominal sepsis in 7 children (age varying from 5 days to 13 y
ears). They consequently underwent planned relaparotomies with periton
eal lavages every 24 to 48 hours. The peritonitis was caused by necrot
izing enterocolitis (3 patients), postoperative complications (3 patie
nts) and long existing perforated appendicitis (1 patient). Physical s
tatus, assessed by the Acute Physiologic Score (A.P.S.), varied from 1
2 to 22 (mean 17.7). Usually more than one lavage was necessary (1 to
3, mean 1.9) before the abdomen was considered clean and the zipper co
uld be removed. Closure of the abdominal cavity could be achieved prim
arily in all cases. All patients survived. Although no statistically s
ignificant conclusions can be drawn from this small series and althoug
h it is unclear whether these children would not have survived without
the zipper, this review shows that planned relaparotomies with perito
neal lavages using a zipper system can be performed safely even in ver
y small children.