STAGED PERITONEAL LAVAGES WITH THE AID OF A ZIPPER SYSTEM IN THE TREATMENT OF DIFFUSE PERITONITIS

A major problem in the surgical treatment of diffuse peritonitis is to obtain a complete clearence of septic foci in the peritoneal cavity w hich may lead to persistence of sepsis and multiple organ failure. We describe our experience with staged abdominal reexplorations using a Z ipper system in 23 patients with a mean APACHE II score of 20.3 (s.e.m : 1.5). A total of 91 lavages were done in these patients. Overall mor tality was 39%. None of the patients having an APACHE II score between 10 and 20 died whereas the predicted mortality was 15%-45%. After suc cessful treatment, primary closure was possible in 8 of the 14 survivi ng patients. Large incisional hernias developed in 6 patients. One pat ient eviscerated two years after complete granulation of his laparosto ma. Staged abdominal reexplorations using a Zipper system is an useful tool in the treatment of diffuse peritonitis.