Castillo BY, Fonseca SFK, Vargas LF

Language: Spanish
References: 15
Page: 1-13
PDF size: 472.29 Kb.

ABSTRACT

Introduction: The lack of a pre-established parameter that allows determining the precise moment to suspend the scheduled peritoneal lavages, often leads to performing insufficient number of them, or perhaps these are unnecessarily prolonged, increasing the probability of the patient´s death.
Objective: To determine the efficacy of peritoneal cytological imprinting in deciding when to stop scheduled peritoneal lavages.
Methods: A descriptive study of diagnostic accuracy was carried out, in a series of cases, with prospective data collection in the five-year period from 2010 to 2014 at Celia Sánchez Manduley Provincial Clinical-Surgical Teaching Hospital. The sample was made up of 42 patients who were treated for persistent secondary peritonitis. They were classified according to four correlation categories, taking paraffin biopsy as reference standard.
Results: Samples with acute peritoneal inflammation and healing of peritoneal inflammation were correctly identified in 39/42 cases. Therefore, the global predictive percentage of the cytological imprint was 92.86%. The sensitivity in the diagnosis of acute peritoneal inflammation was 100%, the specificity was 92.68%, the positive predictive value was 24.99%, and the negative predictive value was 100%. The positive and negative likelihood ratios were 13.67 and 0, respectively. Cohen's kappa coefficient (κ) was 0.376.
Conclusions: The peritoneal cytological imprint is an effective diagnostic method to rule out acute peritoneal inflammation when the result is negative and it was considered very useful to stop scheduled peritoneal lavages.

REFERENCES

1. Van Ruler O, Boermeester MA. Surgical treatment of secondary peritonitis. A continuing problem. Chirurg. 2017;88(Suppl 1):1-6. DOI: 10.1007/s00104-015-0121-x

2. Barreras JC, Mederos ON, Oliva C. Peritonitis terciaria: reintervención y lavado quirúrgico programado y a demanda. En: Soler R, Mederos ON, eds. Cirugía. Afecciones quirúrgicas frecuentes. La Habana: Ecimed; 2018. P. 209-16.

3. Kirkpatrick AW, Coccolini F, Ansaloni L, Roberts DJ, Tolonen M, McKee JL, et al. Closed or Open after Source Control Laparotomy for Severe Complicated Intra-Abdominal Sepsis (the COOL trial): study protocol for a randomized controlled trial. World J Emerg Surg. 2018;13:26-38. DOI: 10.1186/s13017-018-0183-4

4. Soler R. Cirugía del abdomen. Abdomen agudo y lesiones traumáticas abdominales. La Habana: Ecimed; 2010. p. 9-22.

5. Ross JT, Matthay MA, Harris HW. Secondary peritonitis: principles of diagnosis and intervention. BMJ. 2018;361:k1407. DOI: 10.1136/bmj.k1407

6. Scriba MF, Laing GL, Bruce JL, Clarke DL. Repeat laparotomy in a developing world tertiary level surgical service. Am J Surg. 2015;210(4):755-58. DOI: 10.1016/j.amjsurg.2015. 03.024

7. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig L, et al. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ. 2015;351:h5527. DOI: 10.1136/bmj.h5527

8. Goris RJ, Boekhorst TP, Nuytinck JK, Gimbrere JS. Multiple organ failure: generalized autodestructive inflammation? Arch Surg. 1985;120:1109-15. DOI: 10.1001/archsurg. 1985.01390340007001

9. Kamatchi V, Aravindha N, Leena S, Rajesh E. Imprint cytology. J Pharm Bioallied Sci. 2015;7(Suppl 1):S207-8. DOI: 10.4103/0975-7406.155905

10. Ríos N, Ochoa R, Ríos JJ, Goti MA, Pérez JC, Ferrer MA, et al. Patología general. La Habana: Ecimed; 2014. p. 15-6.

11. Vizcaíno GJ. Importancia del cálculo de la sensibilidad, la especificidad y otros parámetros estadísticos en el uso de las pruebas de diagnóstico clínico y de laboratorio. Medicina & Laboratorio. 2017;23:365-86.

12. Valle AR. Curvas ROC (Receiver-Operating-Characteristic) y sus aplicaciones [Tesis de Grado en Matemática]. Sevilla: Universidad de Sevilla; 2017.

13. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-74.

14. Asociación Médica Mundial. Declaración de Helsinki de la AMM - Principios éticos para las investigaciones médicas en seres humanos. Francia: Inc.(AMM). 2021 [acceso 22/10/2021]. [aprox. 4 pantallas]. Disponible en: https://www.wma.net/es/policies-post/declaración-de-helsinki-de-la-amm-principios-eticos-para-las-investigaciones-medicas-en-seres-humanos/14.

15. Martínez MA, Toledo E, Sánchez A. Análisis de concordancia, validez y pronóstico. En: Martínez MA, Toledo E, Sánchez A, Faulin J, eds. Bioestadística amigable. Barcelona: Elsevier España; 2017. p. 470-71.