Abstract
Abstract Introduction Post-operative peritonitis is a life-threatening complication of surgical care, whereby early relaparotomy is paramount in diagnosing and controlling the infective source. Currently, there are no clear guidelines on surgical strategies for re-laparotomy. This study aimed to evaluate the current evidence on the mortality rates and length of hospital admission associated with planned (PR) versus on-demand re-laparotomy (ODR) in patients with secondary peritonitis. Methods Literature review was conducted using Ovid MEDLINE and PubMed to identify English-language papers directly comparing ODR and PR in adults over 18 years. Case reports, reviews and papers including individuals with peritonitis post-pancreatitis or abdominothoracic surgery were excluded. Eight of the 154 studies identified met inclusion criteria following abstract screening. Results No significant difference was found between post-operative mortality in PR and ODR for patients with secondary peritonitis (mean mortality rates 30.0% and 31.7% respectively). ODR was shown to have better overall outcomes in avoiding unnecessary surgeries, reducing infection-related complications and length of ITU admissions. ODR is favoured provided there is no operation delay. However, in patients with extensive peritonitis and high APACHE-II scores, PR is preferred to effectively control infection source. Conclusion Literature analysis shows there is still much debate regarding whether PR or ODR is favoured for post-operative peritonitis. Further randomised control-trials across multiple international centres are required to improve the evidence base for future surgical practice. Take-home message Mortality and complication rates are comparable following planned and on-demand re-laparotomy in patients with post-operative peritonitis. Further international research is required to construct evidence-based guidelines for re-laparotomy and improve our future care for critically unwell surgical patients.
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