title: Surgical management of severe secondary peritonitis.
abstract: BACKGROUND
  Despite advances in diagnosis, surgery, antimicrobial therapy and intensive care support, the mortality rate associated with severe secondary peritonitis remains unacceptably high. This article presents various surgical treatment strategies for severe secondary peritonitis, emphasizing the role of open management of the abdomen and planned relaparotomies.
  
  
  METHODS
  Material was identified from previous review articles, references cited in original papers and a Medline search of the literature.
  
  
  CONCLUSIONS
  Surgical treatment of severe secondary peritonitis is highly demanding and very complex. The combination of improved surgical techniques, antimicrobial therapy and intensive care support has improved the outcome of such peritonitis following perforation or anastomotic disruption of the digestive tract, or infected necrotizing pancreatitis. However, aggressive surgical treatment strategies, such as open management of the abdomen and planned relaparotomies, may have reached their limits.
authors.affiliation: Department of Surgery, University Hospital Utrecht, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Bosscha
authors.forename: T J
authors.initials: TJ
authors.lastname: van Vroonhoven
authors.forename: C
authors.initials: C
authors.lastname: van der Werken
mesh_terms: D001424:Bacterial Infections / Q000150:complications / Q000517:prevention & control; D006801:Humans; D010538:Peritonitis / Q000382:microbiology / Q000601:surgery*; D055502:Secondary Prevention