Missed synchronous abscesses were found to contribute greatly to therapeutic failure in the management of subphrenic abscesses. In a study of 43 patients, such failures were almost entirely limited to those patients whose abscesses were drained by various extraperitoneal approaches. Transperitoneal operation, in contrast, made adequate exploration of the several potential abscess sites possible, and permitted complete drainage of all synchronous purulent collections, with corresponding reduction in second operations and death rates. The classic recommendation for extraserous drainage is not supportable on the basis of this study.
Halasz NA. Subphrenic Abscess: Myths and Facts. JAMA. 1970;214(4):724–726. doi:10.1001/jama.1970.03180040032006
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