TREATMENT OF GENERALIZED PERITONITIS BY A BDOMINAL-CAVITY FENESTRATION

The authors suggest a new method for the treatment of generalized peri tonitis. It is based on the use of a device of the authors' constructi on which allow's the condition of the abdominal cavity to be visualize d continuously and the cavity to be cleansed regularly with the aid of laparoscope. The method is called fenestration of the abdominal cavit y. The authors had 395 patients with purulent peritonitis, 171 (43.3 % ) of them were treated by the semiopen method, 41 of these patients (1 0.4 %) were subjected to fenestration of the abdominal cavity. The aut hors consider fenestration indicated in generalized peritonitis with s igns of polyorganic insufficiency in the presence of a large amount of exudate and concurrent interintestinal, subdiaphragmatic, and pelvic abscesses or when there is a tendency towards their development. With the use of the device for fenestration the number of cleansing relapar otomies was reduced to minimum. Relaparotomy was conducted once in 35, twice in 4, and three times in 2 patients. In all patients the abdomi nal cavity was examined daily with a laparoscope, the exudate was aspi red, and antibiotics were introduced. Phlegmon of the anterior abdomin al wall was an early postoperative complication in 2 patients. Five (1 2.2 %) patients died.