Abstract
<jats:p>Background. The problem of surgical treatment for secondary peritonitis complicated by septic shock is the subject of constant discussions, as it is due to the difficulty in choosing an effective selective surgery and is accompanied by a significant number of complications and high mortality. The purpose was to analyze the features of the course of secondary peritonitis complicated by septic shock and to conduct a comparative analysis on the effectiveness of surgical management with the expansion of indications for the use of programmed relaparotomies with vacuum-assisted closure (VAC). Materials and methods. The work is based on the analysis of the results of surgical treatment of 42 patients with secondary peritonitis complicated by septic shock. Depending on the strategy, the patients were divided into 2 groups: group 1 (comparison, n = 19) and group 2 (main, n = 23) in which improved surgical strategy was used with the expansion of indications for programmed relaparotomies with VAC. Results. The results of the analysis on the structure of surgical diseases in patients with secondary peritonitis complicated by septic shock revealed a perforating complication as the cause of peritonitis in 9 (47.36 %) patients of the first group and 12 (52.17 %) patients of the second group. This was due to perforated gastric ulcer in 2 (10.53 %) patients of the first and 2 (8.69 %) patients of the second group. In almost every third (7 people (36.84 %)) participant of the first group and almost half (10 people (43.48 %) participants of the second group, peritonitis with septic shock was caused by perforation of intestinal tumors, and almost half of the patients in both groups had acute vascular insufficiency of intestine. Eight (42.11 %) patients of the first group and 10 (43.48 %) patients of the second group were operated with MPI of 21 to 29 points, and in almost every third (6 people (31.58 %) patient of the first and second groups (9 people (39.13 %), peritonitis course exceeded 29 points on MPI. Improvement of diagnostic and treatment strategy in patients of group 2 with secondary peritonitis complicated by septic shock by expanding indications for the use of laparoscopy allowed performing perforated gastric ulcer suturing in 2 cases, and the combined use of programmed relaparotomy with VAC contributed to the restoration of the digestive canal during their performance in 10 (43.48 %) patients. Conclusions. Improvement of diagnostic and treatment strategy in patients of group 2 with secondary peritonitis complicated by septic shock allowed reducing the number of postoperative complications by 19.91 % and postoperative mortality by 19.68 %.</jats:p>