Abstract
Secondary peritonitis remains associated with high mortality and morbidity rates. Treatment of secondary peritonitis is challenging even in modern medicine. Surgical intervention for source control remains the cornerstone of treatment, beside adequate antimicrobial therapy and resuscitation. A randomized clinical trial showed that relaparotomy on demand (ROD) after initial emergency surgery is the preferred treatment strategy, irrespective of the severity and extent of peritonitis. The effective and safe use of ROD requires intensive monitoring of the patient in a setting where diagnostic tests and decision making about relaparotomy are guaranteed round the clock. The lack of knowledge on timely and adequate patient selection, together with the lack of use of easy but reliable monitoring tools, seems to hamper full implementation of ROD. The accuracy of the relap decision tool is reasonable for prediction of ongoing peritonitis and selection for computer tomography (CT). The value of CT in an early postoperative phase is unclear. Future research and innovative technologies should focus on the additive value of CT in cases of operated secondary peritonitis and on the further optimization of bedside prediction tools to enhance adequate patient selection for intervention in a multidisciplinary setting.
Highlights
Schlüsselwörter Peritonitis · Abdominelle Sepsis · Geplante Relaparotomie · Relaparotomie bei Bedarf · Behandlungsstrategie crease the systemic inflammatory mediator response resulting in an increased incidence of MOF and mortality [22]
A planned strategy was thought to have the advantage of allowing early identification and treatment of persistent peritonitis or new infective foci, but it increases the number of unnecessary relaparotomies [3]
Mortality rates are higher for planned relaparotomy than for on-demand relaparotomy in diffuse purulent or fecal peritonitis (
Summary
Hit-and-run surgery is performed for acute severe peritonitis, the OA is temporary closed with a mesh inlay of negative pressure wound therapy on the OA, and a commitment for delayed abdominal closure is made but not always achieved. This strategy involves multiple sessions of abdominal surgery, spread over several days, even weeks. A planned strategy was thought to have the advantage of allowing early identification and treatment of persistent peritonitis or new infective foci, but it increases the number of unnecessary relaparotomies [3].
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