J.Jpn. Surg. Soc.. 120(1): 37-43, 2019

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Feature topic

SURGICAL TECHNIQUES AND MANAGEMENT TO PREVENT POSTOPERATIVE INFECTION:TREATMENT OF PERFORATING PERITONITIS

The control of the source of infection with surgery is the key to successful treatment of perforating peritonitis. It is important to select appropriate therapeutic antibiotics as part of preoperative management. As a precaution during surgery, a wound protector is recommended after the peritoneal incision. In the case of diverticulum perforation, a procedure for primary anastomosis is performed and a preventive temporary ileostomy is recommended if necessary, but in high-risk cases the Hartmann procedure may be selected. In the case of colorectal cancer perforation, if it is difficult to resect a tumor, an ostomy is made on the proximal side of the tumor and drainage is performed. If tumor resection is possible, curative surgery is performed. However, because of the risk of anastomotic leakage, careful consideration should be given to the selection of the primary anastomosis. Surgical gloves and instruments should be exchanged before closing a laparotomy wound. After surgery, all inserted devices including drainage tubes and urinary catheters should be removed as soon as they become unnecessary. In cases requiring additional surgery such as colostomy closure and radical curative surgery, the basic infection countermeasures, including smoking cessation guidance, oral care, and respiratory education should be considered.

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