2008 Annual Meeting Abstracts

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Background: Management of severe secondary peritonitis (SSP) may require intestinal resections and bowel exteriorization due to an unacceptable high risk for anastomotic dehiscence (AD). Bowel exteriorization can be achieved through loop or terminal stomas. There are no studies addressing the fate of these latter.Aim: To determine factors associated with AD and mortality in patients submitted to restoration of intestinal continuity after creation of terminal stomas as part of their operative management for SSP.
Material and Methods: We analyzed prospectively collected databases on all consecutive patients with SSP submitted to restoration of intestinal continuity after having had terminal ileostomies (TI) or terminal colostomies (TC) as part of their operative management during a 30 month period. Several patient, disease and operative variables were evaluated as factors related to AD and mortality in this group of patients. Univariate statistical comparisons were made using Student’s T Test for continuous variables and chi-square or Fischer’s exact test when categorical variables were compared. Multivariate analyses were also performed.
Results: A total of 72 male patients and 36 female patients were included in the study; 54 had TI and 54 TC. Median number of operations performed as part of their management for SSP (prior to stomal closure) were 2.5 (range, 1-15). A total of 76 (70%) had had generalized peritonitis and 33 (30%) required management with an open abdomen (20 of them with a skin only closure technique). Median time interval between stomal creation and closure was 190 days (range, 14-2192). Stapled and hand sewn anastomosis were done in 23 and 85 patients, respectively. AD occurred in 11 patients (10%).Univariate analyses disclosed management with an open abdomen (p<0.03) and lower preoperative hemoglobin values (p<0.05) as risk factors for AD. None prevailed after multivariate analyses. A total of 7 patients died (6%). Factors associated with mortality were preoperative use of TPN (p<0.03), lower preoperative hemoglobin values (p<0.05), time interval between stomal creation and closure < 3 months (p<0.01), AD (p<0.01) and need for reoperation after stomal closure (p<0.02). After multivariate analyses, AD and need for reoperation almost achieved statistical significance (p<0.06); time interval between stomal creation and closure < 3 months was the only factor that prevailed as a risk for mortality.
Conclusions: Although several variables were related to AD and mortality, waiting longer than 3 months before attempting restoration of intestinal continuity seems to be the best approach in this group of challenging patients.

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