Paradigm change in 30 years peritonitis treatment -- a review on source control.
Peritonitis remains a hot spot for surgeons despite advancements in surgical technique and intensive care treatment. There is an ongoing interest to improve the survival rate by analyzing the pathogenesis and pathophysiology of this threatening disease. - The significance of source control, e.g., eradication of a focus of infection, elimination of microbial contamination and restoration of local environment, is well recognized since the beginning of the last century. Recently the term "source control" has gained new interest with regard to guidelines for clinical studies. It appears that despite stratification in most clinical peritonitis studies there is still a lack of comparability of those studies with regard to source control. A medline search on peritonitis and source control was performed and 90 studies were evaluated for information on source control evaluation. In summary, there is no uniform definition of source control available. Most studies in peritonitis treatment are according to evidence based medicine level 3-5 evidence. Lack of hard scientific evidence how to measure the success of source control had to be substituted by surgical experience. Re-operation or relaparotomy may be considered as acknowledgment that source control failed. Controversy exists about primary anastomosis in the inflammed peritoneum. Despite all efforts and more patients enrolled in studies to improve surgical treatment of peritonitis in thirty years it is obvious that the mortality rate has decreased only marginally from 40% to 30%. Commonly accepted principles for source control documentation and evaluation should be established and confirmed in multi-center studies before further studies with new compounds are started.
Holzheimer
R G
RG
Dralle
H
H
D003140:Communicable Disease Control / Q000379:methods / Q000706:statistics & numerical data*; D003646:Debridement; D004784:Environmental Monitoring / Q000706:statistics & numerical data*; D005858:Germany; D006801:Humans; D007813:Laparotomy; D009102:Multiple Organ Failure / Q000209:etiology / Q000517:prevention & control; D010533:Peritoneal Lavage; D010538:Peritonitis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate