Stellenwert der einzeitigen operativen Peritonitistherapie

Abstract

Background: Peritonitis is, even today, considered a significant source of complications and lethality. Early operative source control, antibiotic therapy and intensive care support are absolute essentials in therapeutical strategies. We hypothesize that a lower morbidity and lethality rate could be achieved among patients treated with a conservative, single-stage surgical approach (relaparotomy on demand) in comparison to multi-stage treatment concepts, which are currently considered the contemporary standards in treatments for Peritonitis. Methods: Retrospective analysis of all patients (n = 231) with diffuse peritonitis that underwent a single-stage surgical treatment concept (relaparotomy on demand). The results were compared to multi-stage concepts in current literature. Results: The 231 patients with diffuse peritonitis averaged a mean Mannheim Peritonitis Index (MPI) of 25,3 points (range, 10-43 points). Source control at the initial operation was possible to a 93% in all of the patients (n= 214/231), of those, 16,9% (n= 36/214) needed reintervention on demand , 83,1% did not require further surgical therapy (n= 178/214). In 7% of all patients (n= 17/231), source control was not possible at the initial operation and multi-stage therapy such as laparostomy and/or programmed relaparotomy was initiated. Overall, 80,5% of all patients (n= 186/231) needed just one initial surgical intervention. The overall morbidity rate was 35,9%, the hospital mortality rate was 14,3%. Mortality rate among patients treated with relaparotomy on demand was 9% (n= 16/178) Conclusions: In agreement with our hypothesis, a conservative, single-stage surgical treatment concept (relaparotomy on demand) for diffuse peritonitis has been shown to achieve a lower mortality and morbidity rate when compared to multi-stage treatment standards for peritonitis (such as programmed relaparotomy) and therefore seems beneficial. As objective indications for timing of ROD are still missing in current literature, prospectively randomized studies would be desirable.