Optimization of comprehensive diagnosis of postoperative peritonitis in patients with hepatobiliary pathologies

Objective: to improve the immediate results of surgical treatment of postoperative peritonitis (PP) in patients with hepatobiliary disorders.

Material and methods: the study included 54 patients with PP, operated in the clinic for surgical diseases №1 named after Academician K.M. Kurbonov. 83.3% of participants were women. In light of the introduction of new technology and refined surgical techniques, the patients were divided into two groups: a study group of 24 patients (44.4%) and a comparison group of 30 patients (55.6%) who were treated using conventional diagnostic protocols and operative procedures. Generalized peritonitis was observed in 79.6% of cases, whereas localized, non-encapsulated peritonitis in 20.4%.

Results: the following interventions led to the development of PP in 31.5% of patients: various forms of echinococcectomy (n = 10); atypical liver resection for hepatic haemangioma (n = 2); incision and drainage of a hepatic abscess (n = 3); and repair of liver wounds (n = 2). PP occured in 25 (67.6%) out of 37 cases following conventional open cholecystectomy (n = 14) or cholecystectomy involving the construction of biliodigestive anastomoses (n = 11). In 32.4% of cases, PP occurred as a complication of laparoscopic cholecystectomy involving biliary tract. The effectiveness of the surgical treatment for both patient groups was assessed based on changes in blood leukocyte count and C-reactive protein (CRP) levels on the day of surgery and on postoperative days 2, 4 and 6. On postoperative day 4, the main group had significantly lower CRP levels than the control group.

Conclusion: thus, alongside imaging methods, C-reactive protein (CRP) and interleukin-6 (IL-6) levels are highly informative markers for the early diagnosis of postoperative peritonitis. Using these markers enables timely, pathogenetically guided preoperative management and facilitates the selection of the most appropriate corrective intervention.

1. Makhmadov F.I., Sadulloev D.N., Murodov A.I., Ashurov A.S. et al. Relaparotomy and repeated minimally invasive interventions in hepatobiliary surgery. Health сare of Tajikistan 2022;353(2):54-59. doi: 10.52888/0514-2515-2022-353-2-55-60

2. Abdullaev M.R., Aliev M.A. Postoperative peritonitis: analysis of 295 cases. Bulletin of the Dagestan Medical Academy. 2017;24(3):32-35.

3. Chernyadyev S.A., Kubasov K.A., Bulaeva E.I. Differentiated approach to the treatment of patients with widespread peritonitis requiring sanitation relaparotomies. Bulletin of the Ural State University. 2020; 1-2: 72-74. http://elib.usma.ru/handle/usma/2121

4. Launey Y, Duteurtre B, Larmet R, et al. Risk factors for mortality in postoperative peritonitis in critically ill patients. World J Crit Care Med. 2017;6:48-55. DOI: 10.5492/wjccm.v6.i1.48

5. Ivanovich SV. Early X-ray Diagnosis Post-operative Peritonitis. J Clin Res Radiol. 2018;1(1):1-2. DOI:10.33309/2639-913X.010105.