title: [Surgical treatment of secondary peritonitis: A continuing problem. German version].
abstract: BACKGROUND
  Secondary peritonitis remains associated with high mortality and morbidity rates. Treatment of secondary peritonitis is still challenging even in the era of modern medicine. Surgical intervention for source control remains the cornerstone of treatment besides adequate antimicrobial therapy and when necessary intensive medical care measures and resuscitation. A randomized clinical trial showed that relaparotomy on demand (ROD) after initial emergency surgery was the preferred treatment strategy, irrespective of the severity and extent of peritonitis.
  
  
  CONCLUSIONS
  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 seem to hamper full implementation of ROD. The accuracy of the relaparotomy decision tool is reasonable for prediction of the formation of peritonitis and necessary selection of patients for computed tomography (CT). The value of CT in the early postoperative phase is unclear. Future research and innovative technologies should focus on the additive value of CT after surgical treatment for secondary peritonitis and on the further optimization of bedside prediction tools to enhance adequate patient selection for interventions in a multidisciplinary setting.
authors.affiliation: Department of Surgery, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, Niederlande.
authors.forename: O
authors.initials: O
authors.lastname: van Ruler
authors.affiliation: Department of Surgery, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, Niederlande. m.a.boermeester@amc.uva.nl.
authors.forename: M A
authors.initials: MA
authors.lastname: Boermeester
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D019983:Guideline Adherence; D006801:Humans; D007362:Intensive Care Units; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D008991:Monitoring, Physiologic; D010538:Peritonitis / Q000209:etiology* / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D018805:Sepsis / Q000209:etiology / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents
keywords: Abdominal sepsis; On-demand relaparotomy; Peritonitis; Planned relaparotomy; Treatment strategy