The high rate of stoma placement during emergency laparotomy for secondary peritonitis is a paradigm in need of change in the current fast-track surgical setting. Despite growing evidence for the feasibility of primary bowel reconstruction in a peritonitic environment, little data substantiate a surgeons’ choice between a stoma and an anastomosis. The aim of this retrospective analysis is to identify pre- and intraoperative parameters that predict the leakage risk for enteric sutures placed during source control surgery (SCS) for secondary peritonitis. Between January 2014 and December 2020, 497 patients underwent SCS for secondary peritonitis, of whom 187 received a primary reconstruction of the lower gastro-intestinal tract without a diverting stoma. In 47 (25.1%) patients postoperative leakage of the enteric sutures was directly confirmed during revision surgery or by computed tomography. Quantifiable predictors of intestinal suture outcome were detected by multivariate analysis. Length of intensive care, in-hospital mortality and failure of release to the initial home environment were significantly higher in patients with enteric suture leakage following SCS compared to patients with intact anastomoses (p < 0.0001, p = 0.0026 and p =0.0009, respectively). Reduced serum choline esterase (sCHE) levels and a high extent of peritonitis were identified as independent risk factors for insufficiency of enteric sutures placed during emergency laparotomy. A preoperative sCHE < 4.5 kU/L and generalized fecal peritonitis associate with a significantly higher incidence of enteric suture insufficiency after primary reconstruction of the lower gastro-intestinal tract in a peritonitic abdomen. These parameters may guide surgeons when choosing the optimal surgical procedure in the emergency setting.

中文翻译：

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术前血清胆碱酯酶水平降低和粪便腹膜污染是继发​​性腹膜炎源头控制后肠缝线渗漏的潜在预测因素


继发性腹膜炎紧急剖腹手术期间造口放置率很高，这是当前快速手术环境中需要改变的范例。尽管越来越多的证据表明在腹膜环境中进行初次肠道重建的可行性，但很少有数据证实外科医生在造口和吻合之间的选择。本回顾性分析的目的是确定术前和术中参数，预测继发性腹膜炎源控制手术 (SCS) 期间放置的肠缝线的渗漏风险。 2014年1月至2020年12月期间，497名患者因继发性腹膜炎接受了SCS，其中187名患者接受了下胃肠道的初次重建，没有改道造口。 47 名 (25.1%) 患者术后肠缝线渗漏是在翻修手术或计算机断层扫描中直接证实的。通过多变量分析检测肠缝合结果的可量化预测因子。与吻合完整的患者相比，SCS 后发生肠缝线渗漏的患者的重症监护时间、院内死亡率和无法返回初始家庭环境的时间显着较高（分别为 p < 0.0001、p = 0.0026 和 p = 0.0009） 。血清胆碱酯酶（sCHE）水平降低和腹膜炎程度高被确定为紧急剖腹手术期间肠缝合不足的独立危险因素。术前 sCHE < 4.5 kU/L 和全身性粪便性腹膜炎与腹膜腹部下消化道初次重建后肠缝合不全的发生率显着升高相关。 这些参数可以指导外科医生在紧急情况下选择最佳手术程序。