Differential approach to preoperative preparations for diffuse purulent peritonitis in children

Abstract

BACKGROUND: Diffuse purulent peritonitis is the most severe complication of abdominal surgical pathology accompanied by the development of serious metabolic disorders, and its elimination is a preoperative task.

AIM: This study aimed to compare traditional preoperative preparations using a new scheme that provides a differential approach considering the stage of peritonitis, degree of endotoxicosis, child’s age, and succinate administration.

MATERIALS AND METHODS: An analysis of the results of treatment of patients aged 1–14 years (average age 7.9 ± 3.9 years) with diffuse purulent peritonitis of various etiologies who were treated from 2006 to 2022 in the children’s surgical department of the V.D. Seredavin Samara Regional Hospital, Samara. The patients were divided into two groups. The main group included 237 patients who underwent preoperative preparation according to the proposed scheme (depending on age, peritonitis stage, and degree of endotoxemia) lasting at least 4–6 h. In addition, for intracorporeal detoxification, the antihypoxant meglumine sodium succinate was used. The control group comprised 102 children who received traditional therapy according to generally accepted approaches and national guidelines for pediatric surgery lasting 2–3 h. Changes in hemodynamic parameters, electrolytes, hematocrit, platelets, and blood gases were comprehensively examined.

RESULTS: After preoperative preparation, a statistically significant improvement in hemodynamic parameters was observed in the main group compared with that in the control group; the indicators were close to normal values. The dynamics of hematological parameters indicated more pronounced hemodilution in patients of the main group of all ages, which proves a significant improvement in the rheological properties of blood. Electrolyte and blood gas indicators did not reach the indicators of healthy children in any groups; however, in the main group, they were closer to normal. Complications of varying severity in the main group occurred in 21 children (8.8% ± 1.4%; p < 0.001), whereas in the control group, they were diagnosed in 47 patients (46.0% ± 4.6%). A statistically significant reduction in the length of stay of patients in the intensive care unit after surgery was noted in 80% of children in the main group.

CONCLUSIONS: The proposed scheme of preoperative preparation based on a differential approach using the antihypoxant meglumine sodium demonstrated greater effectiveness than traditional treatment. The composition, volume, and duration of preoperative preparation are dependent on the state of homeostasis and the age of the patient.

Keywords

widespread purulent peritonitis / preoperative preparation / hemodynamics / infusion therapy / antihypoxants / meglumine sodium succinate / children

References

[1] Mishra SP, Tiwary SK, Mishra M, Gupta SK. An introduction of tertiary peritonitis. J Emerg Trauma Shock. 2014;7(2):121–123. doi: 10.4103/0974-2700.130883

[2] Mishra S.P., Tiwary S.K., Mishra M., Gupta S.K. An introduction of tertiary peritonitis // J Emerg Trauma Shock. 2014. Vol. 7, N. 2. P. 121–123. doi: 10.4103/0974-2700.130883

[3] Mishra SP, Tiwary SK, Mishra M, Gupta SK. An introduction of tertiary peritonitis. J Emerg Trauma Shock. 2014;7(2):121–123. doi: 10.4103/0974-2700.130883

[4] Camara SN, Haba M, Balde OT, et al. Acute generalized peritonitis of appendicular origin: Epidemiological, clinical and therapeutic aspects at the Sino-Guinean Friendship Hospital. GSC Advanced Research and Reviews. 2021;7(2):087–092. doi: 10.30574/gscarr.2021.7.2.0109

[5] Camara S.N., Haba M., Balde O.T., et al. Acute generalized peritonitis of appendicular origin: Epidemiological, clinical and therapeutic aspects at the Sino-Guinean Friendship Hospital // GSC Advanced Research and Reviews. 2021. Vol. 7, N. 2. P. 087–092. doi: 10.30574/gscarr.2021.7.2.0109

[6] Camara SN, Haba M, Balde OT, et al. Acute generalized peritonitis of appendicular origin: Epidemiological, clinical and therapeutic aspects at the Sino-Guinean Friendship Hospital. GSC Advanced Research and Reviews. 2021;7(2):087–092. doi: 10.30574/gscarr.2021.7.2.0109

[7] Avakimyan VA, Karipidi GK, Avakimyan SV, et al. programmed relaparotomy in the treatment of general purulent peritonitis. Kuban scientific medical bulletin. 2017;24(6):12–16. EDN: ZWHEZL doi: 10.25207/1608-6228-2017-24-6-12-16

[8] Авакимян В.А., Карипиди Г.К., Авакимян С.В., и др. Программированная лапаротомия в лечении разлитого гнойного перитонита // Кубанский научный медицинский вестник. 2017. Т. 24, № 6. С. 12–16. EDN: ZWHEZL doi: 10.25207/1608-6228-2017-24-6-12-16

[9] Avakimyan VA, Karipidi GK, Avakimyan SV, et al. programmed relaparotomy in the treatment of general purulent peritonitis. Kuban scientific medical bulletin. 2017;24(6):12–16. EDN: ZWHEZL doi: 10.25207/1608-6228-2017-24-6-12-16

[10] Muller V, Koplin G, Pratschke J, Raue W. The treatment of acute secondary peritonitis: A retrospective analysis of the use of continuous negative pressure therapy. Med Klin Intensivmed Notfmed. 2018;113(4):299–304. doi: 10.1007/s00063-017-0309-6

[11] Muller V., Koplin G., Pratschke J., Raue W. The treatment of acute secondary peritonitis: A retrospective analysis of the use of continuous negative pressure therapy // Med Klin Intensivmed Notfmed. 2018. Vol. 113, N. 4. P. 299–304. doi: 10.1007/s00063-017-0309-6

[12] Muller V, Koplin G, Pratschke J, Raue W. The treatment of acute secondary peritonitis: A retrospective analysis of the use of continuous negative pressure therapy. Med Klin Intensivmed Notfmed. 2018;113(4):299–304. doi: 10.1007/s00063-017-0309-6

[13] Kumar D, Garg I, Sarwar AH, et al. Causes of acute peritonitis and its complication. Cureus. 2021;13(5):1530. doi: 10.7759/cureus.15301

[14] Kumar D., Garg I., Sarwar A.H., et al. Causes of acute peritonitis and its complication // Cureus. 2021. Vol. 13, N. 5. ID 1530. doi: 10.7759/cureus.15301

[15] Kumar D, Garg I, Sarwar AH, et al. Causes of acute peritonitis and its complication. Cureus. 2021;13(5):1530. doi: 10.7759/cureus.15301

[16] Strionova VS, Nalyotov AV, Shcherbinin AV, Rogovoy AN. Features of the appendicular peritonitis in children. Universiti clinic. 2021;(3):93–97. EDN: WJNFMI doi: 10.26435/uc.v0i3(40).668с

[17] Стрионова В.С., Налетов А.В., Щербинин А.В., Роговой А.Н Особенности течения аппендикулярного перитонита у детей // Университетская клиника. 2021. № 3. С. 93–97. EDN: WJNFMI doi: 10.26435/uc.v0i3(40).668с

[18] Strionova VS, Nalyotov AV, Shcherbinin AV, Rogovoy AN. Features of the appendicular peritonitis in children. Universiti clinic. 2021;(3):93–97. EDN: WJNFMI doi: 10.26435/uc.v0i3(40).668с

[19] Abakumov MM, Bagnenko SF, Beloborodov VB, et al. Abdominal surgical infection: Russian national recommendations. Moscow: Medical Information Agency, 2018. 168 p. (In Russ.)

[20] Абакумов М.М., Багненко С.Ф., Белобородов В.Б., и др. Абдоминальная хирургическая инфекция: Российские национальные рекомендации. 2-е изд., перераб. доп. Москва: Медицинское информационное агентство, 2018. 168 с.

[21] Abakumov MM, Bagnenko SF, Beloborodov VB, et al. Abdominal surgical infection: Russian national recommendations. Moscow: Medical Information Agency, 2018. 168 p. (In Russ.)

[22] Grigoriev EG, Krivtsov GA, Plotkin LL, et al. Acute peritonitis. Clinical recommendations. Moscow, 2017. 91 p. (In Russ.)

[23] Григорьев Е.Г., Кривцов Г.А., Плоткин Л.Л., и др. Острый перитонит. Клинические рекомендации. Москва, 2017. 91 с.

[24] Grigoriev EG, Krivtsov GA, Plotkin LL, et al. Acute peritonitis. Clinical recommendations. Moscow, 2017. 91 p. (In Russ.)

[25] Abichev NM, Jilkaidarov AD, Gladinetc MM. Errors, hazards, and complications in the treatment of patients with generalized purulent peritonitis. Science and healthcare. 2013;(3):43–45. EDN: WADBPN

[26] Абишев Н.М., Жилкайдаров А.Д., Гладинец М.М. Ошибки, опасности и осложнения при лечении больных с разлитым гнойным перитонитом // Наука и здравоохранение. 2013. № 3. С. 43–45. EDN: WADBPN

[27] Abichev NM, Jilkaidarov AD, Gladinetc MM. Errors, hazards, and complications in the treatment of patients with generalized purulent peritonitis. Science and healthcare. 2013;(3):43–45. EDN: WADBPN

[28] Sataev VU, Mironov PI, Mamleev IA, Gumerov AA. Role of planned interventions assisted surgery in the outcome of abdominal sepsis in children. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2013;3(1):22–27. EDN: PZVTQN

[29] Сатаев В.У., Миронов П.И., Мамлеев И.А., Гумеров А.А. Роль эндовидеохирургических плановых вмешательств в исходах абдоминального сепсиса у детей // Российский вестник детской хирургии, анестезиологии и реаниматологии. 2013. Т. 3, № 1. С. 22–27. EDN: PZVTQN

[30] Sataev VU, Mironov PI, Mamleev IA, Gumerov AA. Role of planned interventions assisted surgery in the outcome of abdominal sepsis in children. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2013;3(1):22–27. EDN: PZVTQN

[31] Coral LEB, Gomez Ceron LN, Delgado Bravo AI. Peritonitis treated by laparoscopy as an effective treatment. Rev Gastroenterol Peru. 2018;38(3):261–264

[32] Coral L.E.B., Gomez Ceron L.N., Delgado Bravo A.I. Peritonitis treated by laparoscopy as an effective treatment // Rev Gastroenterol Peru. 2018. Vol. 38, N. 3. P. 261–264

[33] Coral LEB, Gomez Ceron LN, Delgado Bravo AI. Peritonitis treated by laparoscopy as an effective treatment. Rev Gastroenterol Peru. 2018;38(3):261–264

[34] Spichak AI, Naumov PV, Volosnikov DK. Experience of using the drug “Reamberin” in paediatric oncological practice. Pediatric bulletin of the South Ural. 2014;(1-2):74–78. EDN: TOTSAJ

[35] Спичак И.И., Наумов П.В., Волосников Д.К. Опыт применения препарата «Реамберин» в детской онкологической практике // Педиатрический вестник Южного Урала. 2014. № 1-2. С. 74–78. EDN: TOTSAJ

[36] Spichak AI, Naumov PV, Volosnikov DK. Experience of using the drug “Reamberin” in paediatric oncological practice. Pediatric bulletin of the South Ural. 2014;(1-2):74–78. EDN: TOTSAJ

[37] Aleksandrovich YuS, Pshenisnov KV. Infusion Antihypoxants in children with critical conditions. General Reanimatology. 2014;10(3):61–76. EDN: SUFUVP doi: 10.15360/1813-9779-2014-3-59-74

[38] Александрович Ю.С., Пшениснов К.В. Инфузионные антигипоксанты при критических состояниях у детей // Общая реаниматология. 2014. Т. 10, № 3. С. 61–76. EDN: SUFUVP doi: 10.15360/1813-9779-2014-3-59-74

[39] Aleksandrovich YuS, Pshenisnov KV. Infusion Antihypoxants in children with critical conditions. General Reanimatology. 2014;10(3):61–76. EDN: SUFUVP doi: 10.15360/1813-9779-2014-3-59-74

[40] Romantsova MG, Kovalenko AL. Reamberine in clinical practice. Practical guide for doctors. Saint Petersburg, 2011. 198 p. (In Russ.)

[41] Романцова М.Г., Коваленко А.Л. Реамберин в клинической практике. Практическое руководство для врачей. Санкт-Петербург, 2011. 198 c.

[42] Romantsova MG, Kovalenko AL. Reamberine in clinical practice. Practical guide for doctors. Saint Petersburg, 2011. 198 p. (In Russ.)

[43] Zavyalkin VA, Barskaya MA, Varlamov AV, et al. Influence of the antihypoxantic therapy on children with generalized peritonitis. Pirogov Russian journal of surgery. 2016;(12):88–92. EDN: XVOVQT doi: 10.17116/hirurgia20161288-92

[44] Завьялкин В.А., Барская М.А., Варламов А.В., и др. Влияние антигипоксантов на результаты лечения распространенного перитонита у детей // Хирургия. Журнал им. Н.И. Пирогова. 2016. № 12. С. 88–92. EDN: XVOVQT doi: 10.17116/hirurgia20161288-92

[45] Zavyalkin VA, Barskaya MA, Varlamov AV, et al. Influence of the antihypoxantic therapy on children with generalized peritonitis. Pirogov Russian journal of surgery. 2016;(12):88–92. EDN: XVOVQT doi: 10.17116/hirurgia20161288-92

[46] Lazarev VV, Anchutin PE. Effects of succinates on the inflammatory response: a review. Annals of Critical Care. 2023;(3):155–165. EDN: IVCGIF doi: 10.21320/1818-474X-2023-3-155-165

[47] Лазарев В.В., Анчутин П.Е. Влияние сукцинатов на воспалительную реакцию: обзор литературы // Вестник интенсивной терапии им. А.И. Салтанова. 2023. № 3. С. 155–165. EDN: IVCGIF doi: 10.21320/1818-474X-2023-3-155-165

[48] Lazarev VV, Anchutin PE. Effects of succinates on the inflammatory response: a review. Annals of Critical Care. 2023;(3):155–165. EDN: IVCGIF doi: 10.21320/1818-474X-2023-3-155-165

[49] Razumovsky AYu. Paediatric surgery. National guide. Razumovsky AYu, editor. Moscow: GEOTAR-Media, 2021. 1280 p. (In Russ.)

[50] Разумовский А.Ю. Детская хирургия. Национальное руководство / под ред. А.Ю. Разумовского. Москва: ГЭОТАР-Медиа, 2021. 1280 с.

[51] Razumovsky AYu. Paediatric surgery. National guide. Razumovsky AYu, editor. Moscow: GEOTAR-Media, 2021. 1280 p. (In Russ.)

[52] Shamsiev AM, Yusupov ShA, Ryazantsev VA, et al. The features of preoperational preparation of children with diffuse types of appendicular peritonitis. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2013;3(1):88–92. EDN: PZVTVD

[53] Шамсиев А.М., Юсупов Ш.А., Рязанцев В.А., и др. Особенности предоперационной подготовки детей с распространенными формами аппендикулярного перитонита // Российский вестник детской хирургии, анестезиологии и реаниматологии. 2013. Т. 3, № 1. С. 88–92. EDN: PZVTVD

[54] Shamsiev AM, Yusupov ShA, Ryazantsev VA, et al. The features of preoperational preparation of children with diffuse types of appendicular peritonitis. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2013;3(1):88–92. EDN: PZVTVD

[55] Yusupov SA, Atakulov JO, Shukurova GO, et al. The features of perioperational preparation of children with diffuse types of appendicular peritonitis. Science and Education. 2023;4(9):118–127.

[56] Юсупов Ш.А., Атакулов Ж.О., Шукурова Г.О., и др. Периоперационное ведение детей с распространенными формами аппендикулярного перитонита // Science and Education. 2023. Т. 4, № 9. С. 118–127.

[57] Yusupov SA, Atakulov JO, Shukurova GO, et al. The features of perioperational preparation of children with diffuse types of appendicular peritonitis. Science and Education. 2023;4(9):118–127.

[58] Aleksandrovich YuS, Vorontsova NYu, Grebennikov VА, et al. Recommendations on infusion-transfusion therapy in children undergoing surgery. Messenger of anesthesiology and resuscitation. 2018;15(2):68–84. EDN: XMOGBF doi: 10.21292/2078-5658-2018-15-2-68-84

[59] Александрович Ю.С., Воронцова Н.Ю., Гребенников В.А., и др. Рекомендации по проведению инфузионно-трансфузионной терапии у детей во время хирургических операций // Вестник анестезиологии и реаниматологии. 2018. Т. 15, № 2. С. 68–84. EDN: XMOGBF doi: 10.21292/2078-5658-2018-15-2-68-84

[60] Aleksandrovich YuS, Vorontsova NYu, Grebennikov VА, et al. Recommendations on infusion-transfusion therapy in children undergoing surgery. Messenger of anesthesiology and resuscitation. 2018;15(2):68–84. EDN: XMOGBF doi: 10.21292/2078-5658-2018-15-2-68-84

[61] Bailey AG, McNaull PP, Jooste E, Tuchman JB. Perioperative crystalloid and colloid fluid management in children: where are we and how did we get here? Anesth Analg. 2010;110(2):375–390. doi: 10.1213/ANE.0b013e3181b6b3b5

[62] Bailey A.G., McNaull P.P., Jooste E., Tuchman J.B. Perioperative crystalloid and colloid fluid management in children: where are we and how did we get here? // Anesth Analg. 2010. Vol. 110, N. 2. P. 375–390. doi: 10.1213/ANE.0b013e3181b6b3b5

[63] Bailey AG, McNaull PP, Jooste E, Tuchman JB. Perioperative crystalloid and colloid fluid management in children: where are we and how did we get here? Anesth Analg. 2010;110(2):375–390. doi: 10.1213/ANE.0b013e3181b6b3b5

[64] Chhabada S, Licina L, Gupta N. Perioperative fluid management in pediatric patients. In: Farag E, Kurz A, Troianos C, editors. Perioperative fluid management. Springer, Cham. 2020. P. 387–408. doi: 10.1007/978-3-030-48374-6_17

[65] Chhabada S., Licina L., Gupta N. Perioperative fluid management in pediatric patients. In: Farag E., Kurz A., Troianos C., ed. Perioperative fluid management. Springer, Cham. 2020. P. 387–408. doi: 10.1007/978-3-030-48374-6_17

[66] Chhabada S, Licina L, Gupta N. Perioperative fluid management in pediatric patients. In: Farag E, Kurz A, Troianos C, editors. Perioperative fluid management. Springer, Cham. 2020. P. 387–408. doi: 10.1007/978-3-030-48374-6_17

[67] Starokon PM, Altunyan VL, Asanov ON, Galik NI. Disseminated peritonitis: methods of detoxification. In: Larichev AB, editor. Proceedings of the IX All-Russians conferences of general surgeons with international participation: “Peritonitis from A to Z (All-Russian school)”; 2016 May 18–19; Yaroslavl. Yaroslavl: Avers-Plus, 2016. P. 425–427. (In Russ.)

[68] Староконь П.М., Алтунян В.Л., Асанов О.Н., Галик Н.И. Распространенный перитонит: методы детоксикации. В кн.: Материалы IX Всероссийской конференции общих хирургов с международным участием: «Перитонит от а до я (Всероссийская школа)»; 18–19 мая 2016 г.; Ярославль / под ред. А.Б. Ларичева. Ярославль: Аверс-Плюс, 2016. С. 425–427.

[69] Starokon PM, Altunyan VL, Asanov ON, Galik NI. Disseminated peritonitis: methods of detoxification. In: Larichev AB, editor. Proceedings of the IX All-Russians conferences of general surgeons with international participation: “Peritonitis from A to Z (All-Russian school)”; 2016 May 18–19; Yaroslavl. Yaroslavl: Avers-Plus, 2016. P. 425–427. (In Russ.)

[70] Gostischev VK, Sazhin VP, Avdovenko AL. Peritonitis: textbook for students of medical universities. Moscow: Medicine, 1992. 223 p. (In Russ.)

[71] Гостищев В.К., Сажин В.П., Авдовенко А.Л. Перитонит: учебное пособие для студентов медицинских вузов. Москва: Медицина, 1992. 223 с.

[72] Gostischev VK, Sazhin VP, Avdovenko AL. Peritonitis: textbook for students of medical universities. Moscow: Medicine, 1992. 223 p. (In Russ.)

[73] Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213. doi: 10.1097/01.sla.0000133083.54934.ae

[74] Dindo D., Demartines N., Clavien P.-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey // Ann Surg. 2004. Vol. 240, N. 2. P. 205–213. doi: 10.1097/01.sla.0000133083.54934.ae

[75] Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213. doi: 10.1097/01.sla.0000133083.54934.ae

[76] Аleksandrovich YuS, Pshenisnov KV. Pre-operative preparation to anesthesia in children. Messenger of anesthesiology and resuscitation. 2020;17(3):79–94. EDN: QZNFOB doi: 10.21292/2078-5658-2020-17-3-79-94

[77] Александрович Ю.С., Пшениснов К.В. Предоперационная подготовка к анестезии у детей // Вестник анестезиологии и реаниматологии. 2020. T. 17, № 3. С. 79–94. EDN: QZNFOB doi: 10.21292/2078-5658-2020-17-3-79-94

[78] Аleksandrovich YuS, Pshenisnov KV. Pre-operative preparation to anesthesia in children. Messenger of anesthesiology and resuscitation. 2020;17(3):79–94. EDN: QZNFOB doi: 10.21292/2078-5658-2020-17-3-79-94

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