One Surgery Often Enough for Peritonitis

One Surgery Often Enough for Peritonitis

Study questions usefulness of secondary procedures
By Randy Dotinga HealthDay Reporter

TUESDAY, Aug. 21 (HealthDay News) -- Patients with a serious gastrointestinal infection known as peritonitis may not automatically need to undergo more operations beyond the first one, new research suggests.

In the United States, most surgeons choose to wait and see if they think patients need the extra surgery, said Dr. David Flum, a gastrointestinal surgeon at the University of Washington, who wrote a commentary about the study.
Until now, however, "there hasn't been a lot of evidence to guide that decision," he said.

The findings are published in the Aug. 22/29 issue of the Journal of the American Medical Association.

Peritonitis occurs when a hole develops in the intestines -- such as when the appendix bursts -- and allows bacteria to spill into the abdominal cavity, Flum said. Severe infection can result.

There's a high risk of death even after surgeons plug up the hole, he said, because bacteria remains and creates problems.
One approach has been to operate and then "keep taking them back to the operating room and washing out the abdominal cavity until they improve," Flum said. "Another strategy is to re-operate when the patient's body is giving you signs that it needs an operation."

In the new study, Dutch researchers at the Academic Medical Center, Amsterdam, examined the impact of each strategy on 225 patients. Only 42 percent of those in the "non-automatic-surgery" group actually went on to have a secondary operation, compared to 94 percent in the automatic-surgery group.
About a third of the patients in both groups died, and the researchers said there was no "significant difference" between their mortality rates.

However, patients who only underwent a second surgery when their doctors thought it necessary spent an average of seven days in intensive care versus 11 days for the other group. They also spent an average of 27 days in the hospital versus 35 days in the automatic-surgery cohort.

Meanwhile, "direct medical costs" were 23 percent less among those who didn't automatically have a subsequent surgery.
"It doesn't like look there's a huge difference in survival," Flum said. "But the approach with fewer operations and less cost would be the preferred one."

Dr. E. Patchen Dellinger, chief of the division of general surgery at the University of Washington, Seattle, said he hopes that questions about the validity of automatic re-operation are now settled.
"An area that could use study is how long antibiotics should be continued in the treatment of peritonitis," said Dellinger, who also wrote a journal commentary on the Dutch study. "Currently, I believe that many [peritonitis] patients get antibiotics for far longer than needed."

More information
There's more on peritonitis at the University of Maryland.
SOURCES: David R. Flum, M.D., associate professor, surgery and surgical outcomes and gastrointestinal surgeon, University of Washington, Seattle; E. Patchen Dellinger, M.D., professor and vice chairman, department of surgery, and chief, division of general surgery, University of Washington, Seattle; Aug. 22/29, 2007, Journal of the American Medical Association

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Indiana Plastic Surgeon Offers Silicone and Saline Breast Implants for Breast Enlargement in Indiana

Indiana Plastic Surgeon Offers Silicone and Saline Breast Implants for Breast Enlargement in Indiana

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“Almost all my patients want a naturally enhanced look. I can provide a more tailored breast augmentation now that there are more implant choices on the table.”

Women can now customize their breast enhancement in Indiana by choosing between saline breast implants and a new generation of silicone gel implants at the Valparaiso or Schererville offices of Indiana plastic surgeon Gustavo E. Galante, MD.

Only 10 months ago, most women considering breast enlargement in Indiana and across the United States had to choose saline implants, the only implant material widely available. But now, following U.S. Food and Drug Administration (FDA) approval of a new generation of silicone gel implants, the choices for breast augmentation in Indiana have grown. Plastic surgeon Dr. Gustavo Galante, after seeing for himself the strong safety record of the new silicone gel implants, has expanded his implant options to include both saline and silicone gel. "Women are excited about having more choices, and there really has been no better time to consider breast enhancement," says Indiana plastic surgeon Dr. Galante. "Almost all my patients want a naturally enhanced look. I can provide a more tailored breast augmentation now that there are more implant choices on the table."Choosing an implant material is only one of the many decisions every woman needs to make when considering breast enlargement.

Indiana women also have a wide array of choices regarding shape, size, and profile. There are literally hundreds of variations possible, allowing Dr. Galante to provide each of his patients with a custom result."The latest silicone gel implants have a consistency remarkably like real breast tissue," adds Dr. Galante. "This is preferable for many patients, particularly those with very little breast tissue of their own.

In these patients, silicone gel implants tend to look more like a natural breast, with a gentle slope away from the collarbone when they stand up, rather than a fixed or overly round appearance that might occur with saline."Various generations of silicone implants have been available in other parts of the world for several decades, but since 1992 they had not been used for most breast surgeries in the United States. Initial safety concerns did not pan out after over a decade of research and technological improvements have increased the durability of this implant type. Modern silicone implants use silicone with a more gel-like consistency, allowing them to hold together better than earlier versions. As a result, silicone migration is much less likely if rupture occurs. "In my experience silicone implants can provide a more attractive breast augmentation result for selected patients, but saline can be an excellent choice for some women, particularly those very worried about safety or implant rupture. Silicone implants have a slightly higher rate of capsular contracture, the hardening of the scar tissue that surrounds the implant.

Also, I can use a slightly smaller incision when placing saline implants, so this may be the right choice if scarring is a big concern."Dr. Galante has the training and experience to provide a pleasing, shapely breast appearance regardless of whether a patient chooses saline or silicone gel. He encourages women interested in breast enhancement to schedule a consultation and learn more about which implant type is right for them. "Ultimately," he says, "it's a personal decision, but I do everything I can to make sure each patient has the facts so she can make the best choice for her breast augmentation goals."

The cosmetic surgery practice of Dr. Gustavo Galante serves Northwest Indiana, with offices in Schererville and Valparaiso. Dr. Galante offers a variety of cosmetic surgery options, including breast augmentation, tummy tucks, liposuction, and face lifts. He is board certified by the American Board of Plastic Surgery, a member of the American Society of Plastic Surgeons, and a fellow of the American College of Surgeons and the American Society of Laser Medicine and Surgery. His practice is committed to creating an environment where each patient can feel comfortable with every step of their surgical experience.