Peritoneal/ Serum Lactate Ratio in Relaparotomy
Condition: Surgical Complications; Relaparotomy
Study type: Observational

Summary: 
      Laparotomy performed for both emergency of elective surgery may by complicated by
      intrabdominal collection, anastomotic leakage, infarction and others. This conditions are
      able to induce peritoneal inflammation. Inflamed peritoneum are able to produce excess of
      lactate that the investigators can measure by collecting fluid from peritoneal drainage.

      Drainage were left in abdomen for monitoring intrabdominal condition until the passage of
      stool or flatus. Minimum drainage of serum is present daily also in uncomplicated post
      operative period.

      Serum lactate relates with increased systemic anaerobic metabolism such as SIRS, sepsis and
      systemic hypoperfusion and it is easy to measure with a blood gas analysis.

      The investigators hypothesized that the increases of peritoneal/ serum lactate ratio could be
      an earlier, sensible, non-invasive, and economical marker of post surgical complications. The
      decision whether and when to perform a relaparotomy in secondary peritonitis is largely
      subjective and based on professional experience. Actually no existing scoring system aids in
      this decision.

      The aim of this study is to demonstrate that this ratio could be and useful tool for the
      surgeon in this decisional process.
    

Detailed description: 
      Post operative intraabdominal sepsis due to surgical complications is associated with an
      important mortality and morbidity. Early diagnosis is crucial to improve outcome.
      Relaparotomy could be necessary to eradicate the intraabdominal focus of sepsis or
      hypoperfusion. The relaparotomy must be performed early after the diagnosis of surgical
      complications before the onset of multi organ failure.

      This prospective observational study includes the post operative period of consecutive
      patients requiring both major elective surgery and urgent laparotomy.

      Demographic data, presence and nature of underlying disease and surgical diagnosis will be
      recorded on admission and study inclusion.

      Daily after study inclusion, the investigators measure: venous blood gases, blood lactate and
      lactate presents in the fluid collected from the abdomen. Possum and SAPSII scores will be
      calculated daily or when a patient develops a rapid clinical deterioration.

      The investigators follow patients with complicated or uncomplicated post operative period.

      Post operative complications are defined as: mesenteric ischemia, need for reintervention,
      anastomotic leakage or fistula, secondary peritonitis and death.

      The primary end point is to demonstrate the correlation between surgical complications and
      serum/abdominal lactate ratio.

      The second end point is to verify the correlation between need to relaparotomy and Possum an
      SAPSII scores.
    

Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Patients admitted to our surgery department for the post operative period after major
        abdominal surgery (neoplastic and non neoplastic) or urgent laparotomy for traumatic or non
        traumatic acute abdomen.
      
Keywords: lactate; urgent surgery; major surgery; surgical complications; possum; sapsII; relaparotomy