CONTROLE CIRÚRGICO DA SEPSE ABDOMINAL: EVIDÊNCIAS ATUAIS, ESTRATÉGIAS MINIMAMENTE INVASIVAS E DESFECHOS CLÍNICOS
DOI:
https://doi.org/10.56238/levv17n58-022Palavras-chave:
Sepse Abdominal, Cirurgia de Emergência, Controle de Foco, Laparotomia, Laparoscopia, MortalidadeResumo
A sepse abdominal permanece como um dos maiores desafios da cirurgia de emergência, sendo responsável por elevada mortalidade em pacientes críticos. O controle cirúrgico do foco infeccioso, aliado à antibioticoterapia precoce e à estabilização hemodinâmica, compõe o tripé essencial do manejo. Este estudo objetivou revisar criticamente as evidências mais recentes sobre a abordagem cirúrgica da sepse abdominal, com ênfase no timing da intervenção, nas estratégias minimamente invasivas e nos impactos clínicos relacionados à sobrevida. Realizou-se uma revisão sistemática conforme as diretrizes PRISMA, por meio das bases PubMed, Scopus, Web of Science e ScienceDirect, abrangendo publicações entre 2010 e 2025. A análise resultou na seleção de oito estudos principais, incluindo coortes multicêntricas, revisões clínicas e diretrizes internacionais. Evidenciou-se que o tempo entre o diagnóstico e o controle de foco cirúrgico é fator prognóstico crítico, com aumento significativo da mortalidade quando a intervenção ultrapassa seis horas. Estratégias como laparoscopia em pacientes estáveis, cirurgia por etapas e laparostomia com reavaliações sucessivas demonstraram melhores desfechos clínicos. Além disso, o papel da hipertensão intra-abdominal, do microbioma intestinal e da abordagem multidisciplinar foi amplamente reforçado como parte integral do tratamento. Conclui-se que a personalização da abordagem cirúrgica, com intervenções precoces e adaptadas à gravidade clínica, é determinante para a redução da mortalidade em pacientes com sepse abdominal.
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