Reconstructive intestinal surgery after open management of severe intraabdominal infection

Open management (OM) of severe intraabdominal infection often is complicate d by fistula formation and the need for complex reconstructive procedures. From 1988 to 1998 a series of 135 patients were treated by OM. Of these pat ients, 24 developed intestinal fistulas and 42 had to be treated by discont inuity resections prior to OM for intestinal perforations or anastomotic in sufficiency. Of the patients with fistulas or enterostomies, 61% survived. Reconstructive surgery was performed after infections had completely subsid ed. Patients were examined on follow-up, and the quality of life was assess ed by 36-item short-form health suny questionnaires. Restorative surgery wa s performed in 32 of 40 patients 102 days (median) after beginning OM. All patients survived. Anastomotic leakage developed in sis patients (18%). Thi rty patients (94%) were followed up; 70% indicated their quality of life to be good. Despite a higher rate of anastomotic problems than with elective visceral operations, reconstructive intestinal surgery after OM may be perf ormed without mortality and satisfying long-term outcome.