The surgical concepts of planned and on-demand reoperation in the treatment of diffuse intra-abdominal infection

Abstract

Background: Planned and “on-demand” reoperations are well established concepts in the management of severe diffuse peritonitis. Both concepts being applied at our surgical department, were reviewed regarding specific complications and lethality. Methods: During a five year study period 62 patients with the diagnosis of diffuse peritonitis underwent operative treatment at the department of surgery, University of Vienna. The mean age of 29 female and 33 male patients was 58.2 years (range 17–93 years). The origin of peritonitis was the stomach in 8.1 %, duodenum in 16.1 %, small intestine in 12.9 %, large intestine in 41.9 % and the pancreas in 16.1 %. Results: Among these 62 patients 15 patients were reoperated according to plan and 47 were reoperated on demand. The intraoperatively gained Mannheim peritonitis index as well as the Apache II Score were similar in both groups. The average number of reoperations was 5 in the group of planned revisions and 3 in the group of on-demand revisions. In both groups mortality was similar. Regarding mortality only the age of the patient (p<0.03) and the preoperatively assessed Apache II Score (p<0.01) reached statistical significance. As expected the eradication of the infectious source was precondition of survival regardeless the type of reoperation. Conclusions: Planned or on-demand reoperations lead to similar results in the surgical treatment of diffuse peritonitis. The crucial point of success is an early as possible and consequent elimination of the infectious source.