When to Operate or to Stop Operating and to Plan a Reoperation

  • A. E. Baue
Conference paper


The indications for an operative procedure have remained much the same for a number of years but there are now several new indications for considering an operation particularly for considering a reoperation. The usual indications for an elective operation must consider the risks versus the benefits. For emergency operations the consideration must be whether or not the procedure is life-saving and again risks versus benefits related to the procedure. What is the risk for the patient what are the potential benefits do they balance out as a win-win situation for the patient his or her family?


Abdominal Compartment Syndrome Open Abdomen Intraabdominal Pressure Intraabdominal Infection Secondary Peritonitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Baue AE (1990) Chapter 25, the particular problem of peritonitis and increased abdominal pressure. In: Baue AE (ed) Multiple Organ Failure. Mosby Year Book, St. Louis, pp. 452–470Google Scholar
  2. 2.
    Polk HC Jr, Shields CL (1977) Remote organ failure: a valid sign of occult intra-abdominal infection. Surgery 81:310–317PubMedGoogle Scholar
  3. 3.
    Fietsam R Jr, Villalba M, Glover JL, Clark K (1989) Intra-abdominal compartment syndrome as a complication of ruptured abdominal aortic aneurysm repair. Am Surg 55:396–402PubMedGoogle Scholar
  4. 4.
    Schein M, Wittmann DH, Aprahamian CC, Condon RE (1995) Collective reviews: the abdominal compartment syndrome: the physiological and clinical consequences of elevated intra-abdominal pressure. J Am Coll Surg 180:745–753PubMedGoogle Scholar
  5. 5.
    Moore EE (1996) Staged laparotomy for the hypothermia, acidosis, and coagulopathy syndrome. Am J Surg 405–410Google Scholar
  6. 6.
    Wittmann DH, Schein M, Condon RE (1996) Management of secondary peritonitis. Ann Surg 224:10–18PubMedCrossRefGoogle Scholar
  7. 7.
    Baue AE (1975) Multiple progressive or sequential system failure: a syndrome of the 1970s. Arch Surg 110:779–781PubMedCrossRefGoogle Scholar
  8. 8.
    Fry DE et al (1980) Determinants of death in patients with intra-abdominal abscess. Surgery 88:517–523PubMedGoogle Scholar
  9. 9.
    Ferraris VA (1983) Exploratory laparotomy for potential abdominal sepsis in patients with multiple-organ failure. Arch Surg 118:1130–1133PubMedCrossRefGoogle Scholar
  10. 10.
    Sinanan M, Maier RV, Carrico CJ (1984) Laparotomy for intra-abdominal sepsis in patients in an intensive care unit. Arch Surg 119:652–658PubMedCrossRefGoogle Scholar
  11. 11.
    Hoogewoud HM et al (1986) The role of computerized tomography in fever, septicemia and multiple system organ failure after laparotomy. Surg Gynecol Obstet 162:539–545PubMedGoogle Scholar
  12. 12.
    Norton LW (1985) Does drainage of intra-abdominal pus reverse multiple organ failure? Am J Surg 149:347–350PubMedCrossRefGoogle Scholar
  13. 13.
    Baue AE (1985) Recovery from multiple organ failure. Am J Surg 149:420–421PubMedCrossRefGoogle Scholar
  14. 14.
    Thorington JM, Schmidt CF (1923) A study of urinary output and blood-pressure changes resulting in experimental ascites. Am J Med Sci 165:880–886CrossRefGoogle Scholar
  15. 15.
    Ranniger K, Switz DM (1965) Local obstruction of the inferior vena cava by massive ascites. J Rad 93:935–939Google Scholar
  16. 16.
    Mullane JF, Gliedman ML (1966) Elevation of the pressure in the abdominal inferior vena cava as a cause of a hepatorenal syndrome in cirrhosis. Surgery 59:1135–1146PubMedGoogle Scholar
  17. 17.
    Bradley SE, Bradley GP (1947) The effect of increased intra-abdominal pressure on renal function in man. J Clin Invest 26:1010–1022CrossRefGoogle Scholar
  18. 18.
    Richards WO, Scovill W, Shin B, Reed W (1983) Acute renal failure associated with increased intra-abdominal pressure. Ann Surg 197:183–187PubMedCrossRefGoogle Scholar
  19. 19.
    Kron IL, Harman PK, Nolan SP (1984) The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg 199:28–30PubMedCrossRefGoogle Scholar
  20. 20.
    Richardson JD, Trinkle JK (1976) Hemodynamic and respiratory alterations with increased intra-abdominal pressure. J Surg Res 20:401–404PubMedCrossRefGoogle Scholar
  21. 21.
    Barnes GE, Laine GA, Giam PY et al (1985) Cardiovascular responses to elevation of intraabdominal hydrostatic pressure. Am J Physio 17:R210-R213Google Scholar
  22. 22.
    Robotham JL, Wise RA, Bromberger-Bamea B (1985) Effects of changes in abdominal pressure on left ventricular performance and regional blood flow. Crit Care Med 13:803–809PubMedCrossRefGoogle Scholar
  23. 23.
    Harman PK, Kron IL, McLachlan HD (1982) Elevated intra-abdominal pressure and renal function. Ann Surg 196(5):594–597PubMedCrossRefGoogle Scholar
  24. 24.
    Diebel LN, Dulchavsky SA, Wilson RF (1992) Effect of increased intra-abdominal pressure on mesenteric arterial and intestinal mucosal blood flow. J Trauma 33(l):45–48PubMedCrossRefGoogle Scholar
  25. 25.
    Diebel LN, Wilson RF, Dulchavsky SA, Saxe J (1992) Effect of increased intra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. J Trauma 33(2):279–282PubMedCrossRefGoogle Scholar
  26. 26.
    Bloomfield GL, Blocher CR, Fakhry IF (1997) Elevated intra-abdominal pressure increases plasma renin activity and aldosterone levels. J Trauma 42(6):997–1005PubMedCrossRefGoogle Scholar
  27. 27.
    Bloomfield GL, Dalton JM, Sugerman HJ et al (1995) Treatment of increasing intracranial pressure secondary to the acute abdominal compartment syndrome in a patient with combined abdominal and head trauma. J Trauma 39(6): 1168–1170PubMedCrossRefGoogle Scholar
  28. 28.
    Pusajo JF, Bumaschny E, Agurrola A et al (1994) Postoperative intra-abdominal pressure: Its relation to splanchnic perfusion, sepsis, multiple organ failure and surgical reintervention. Int Crit Care Dig 13(l):2–4Google Scholar
  29. 29.
    Bendahan J, Coetzee CJ, Papagianopoulos C, Muller R (1995) Abdominal compartment syndrome. J Trauma 38(1): 152–153PubMedCrossRefGoogle Scholar
  30. 30.
    Celoria G, Steingrub J, Dawson JA, Teres D (1987) Oliguria from high intra-abdominal pressure secondary to ovarian mass. Crit Care Med 15(l):78–79PubMedCrossRefGoogle Scholar
  31. 31.
    Iberti TJ, Kelly KM, Gentili DR et al (1987) A simple technique to accurately determine in- tra-abdominal pressure. Crit Care Med 15(12): 1140–1142PubMedCrossRefGoogle Scholar
  32. 32.
    Rapanos T, Boulanger B, McLean R, Brenneman F (1997) Is clinical examination an accurate indicator of intra-abdominal pressure in ventilated trauma patients? Crit Care Med 25 (1):A133Google Scholar
  33. 33.
    Daly RC, Mucha P Jr, Famell MB (1989) Abdominal reexploration for increased intra-abdominal pressure and acute oliguric renal failure. Contemp Surg 35:11–18Google Scholar
  34. 34.
    Howdieshell TR, Yeh ICA, Hawkins ML, Cue (1995) Temporary abdominal wall closure in trauma patients: Indications, technique, and results. World J Surg 19:154–158PubMedCrossRefGoogle Scholar
  35. 35.
    Sherck J, Oakes D, Seiver A et al (1996) The open abdomen in intensive care: A novel approach for coverage. Crit Care Med 24:A73Google Scholar
  36. 36.
    Smith PC, Tweddell JS, Bessey PQ (1992) Alternative approaches to abdominal wound closure in severely injured patients with massive visceral edema. J Trauma 32(1): 16–20PubMedCrossRefGoogle Scholar
  37. 37.
    Sleeman D, Sosa JL, Gonzalez A et al (1995) Reclosure of the open abdomen. J Am Coll Surg 180:200–204PubMedGoogle Scholar
  38. 38.
    Feliciano DV, Mattox KL, Jordan GL (1981) Intra-abdominal packing for control of hepatic hemorrhage — a reappraisal. J Trauma 21:285–290PubMedCrossRefGoogle Scholar
  39. 39.
    Svoboda JA, Peter ET, Dang CV et al (1982) Severe liver trauma in the face of coagulopathy — a case for temporary packing and early reexploration. Am J Surg 144:717–721PubMedCrossRefGoogle Scholar
  40. 40.
    Rotondo MF, Schwab CW, McGonigal MD et al (1993) “Damage control”: An approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 35(3):375–383PubMedCrossRefGoogle Scholar
  41. 41.
    Burch JM, Ortiz VB, Richardson RJ et al (1992) Abbreviated laparotomy and planned reoperation for critically injured patients. Ann Surg 215:476–484PubMedCrossRefGoogle Scholar
  42. 42.
    Hirshberg A, Wall MJ Jr, Mattox KL (1994) Planned reoperation for trauma: A two year experience with 124 consecutive patients. J Trauma 37(3):365–369PubMedCrossRefGoogle Scholar
  43. 43.
    Bemabei AF, Levison MA, Bender JS (1992) The effects of hypothermia and injury severity on blood loss during trauma laparotomy. J Trauma 33(6):835–839CrossRefGoogle Scholar
  44. 44.
    Schein M, Saadia R, Decker G (1988) Intraoperative peritoneal lavage. Surg Gynecol Obstet 166:187–195PubMedGoogle Scholar
  45. 45.
    Silenas R et al (1983) Mechanical effectiveness of closed peritoneal irrigation in peritonitis. Am J Surg 145:371–373PubMedCrossRefGoogle Scholar
  46. 46.
    Hudspeth AS (1975) Radical surgical debridement in the treatment of advanced generahzed bacterial peritonitis. Arch Surg 110:1233–1236PubMedCrossRefGoogle Scholar
  47. 47.
    Polk HC Jr, Fry DE (1980) Radical peritoneal debridement for established peritonitis: the results of a prospective randomized cHnical trial. Ann Surg 192:350–355PubMedCrossRefGoogle Scholar
  48. 48.
    Steinberg D (1979) On leaving the peritoneal cavity open in acute generalized suppurative peritonitis. Am J Surg 137:216–220PubMedCrossRefGoogle Scholar
  49. 49.
    Pichlmayr R et al (1983) Postoperativ Kontinuierliche offene dorso-ventrale Bauchspulung bei schweren formen der Peritonitis. Der Chirug 54:299–305Google Scholar
  50. 50.
    Losanoff J, Kjossev K (1997) Palisade dorsoventral lavage for neglected peritonitis. Am J Surg 173:134–135PubMedCrossRefGoogle Scholar
  51. 51.
    Teichman W, Wittman DH, Andreone PA (1986) Scheduled reoperations (Ettappenlavage) for diffuse peritonitis. Arch Surg 121:147–152CrossRefGoogle Scholar
  52. 52.
    Wittmann DH, Wallace JR The various leaving-the-abdomen-open techniques for advanced severe peritonitis: Mesh, Zippers, Artificial Burr, and Other Methods (in press)Google Scholar
  53. 53.
    Hau T, Ohmann C, Wolmershauser A et al (1995) Planned relaparotomy vs relaparotomy on demand in the treatment of intra-abdominal infections. Arch Surg 130:1193–1197PubMedCrossRefGoogle Scholar
  54. 54.
    Neijenhuis P, Muckart D (1995) Planned relaparotomy: A futile procedure? Surgical Infection Society Europe 8th Annual Meeting S28, 26Google Scholar
  55. 55.
    van Goor H, Hulsebos R, Bleichrodt R (1995) Complications of planned relaparotomies in patients with severe generalized peritonitis. Surgical Infection Society Europe 8th Annual Meeting S28, 25Google Scholar
  56. 56.
    Wittmann DH, Bansal N, Bergstein JM et al (1994) Staged abdominal repair compares favorably with conventional operative therapy for intra-abdominal infections when adjusting for prognostic factors with a logistic model. Theor Surg 25:273–284Google Scholar
  57. 57.
    Pusajo JF, Bumaschny E, Dogho GR et al (1993) Postoperative intra-abdominal sepsis requiring reoperation. Arch Surg 128:218–223PubMedCrossRefGoogle Scholar
  58. 58.
    Mizrahi S, Deutsch M, Hayes D et al (1993) Improved zipper closure of the abdominal wall in patients requiring multiple intra-abdominal operations. Am J Surg 166:62–63PubMedCrossRefGoogle Scholar
  59. 59.
    Wittmann DH, Aphrahamian C, Bergstein JM et al (1993) A burr-like device to facilitate temporary abdominal closure in planned multiple laparotomies. Eur J Surg 159:75–79PubMedGoogle Scholar
  60. 60.
    Andrus C, Doering M, Herrmann VM, Kaminski DL (1986) Planned reoperation for generalized intraabdominal infection. Am J Surg 152:682–686PubMedCrossRefGoogle Scholar
  61. 61.
    Kinney EV, Polk HC (1987) Open treatment of peritonitis: an argument against. Adv Surg 21: 19–28Google Scholar
  62. 62.
    Wickel DJ, Cheadle WG, Mercer-Jones MA, Garrison RN (1997) Poor outcome from peritonitis is caused by disease acuity and organ failure, not recurrent peritoneal infection. Ann Surg 225:744–756PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia, Milano 1998

Authors and Affiliations

  • A. E. Baue

There are no affiliations available

Personalised recommendations