title: Surgical treatment of secondary peritonitis : A continuing problem.
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.
authors.affiliation: Department of Surgery, Academic Medical Center, 1100 DD, P.O. Box 22660, Amsterdam, The Netherlands.
authors.forename: O
authors.initials: O
authors.lastname: van Ruler
authors.affiliation: Department of Surgery, Academic Medical Center, 1100 DD, P.O. Box 22660, Amsterdam, The Netherlands. 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; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D008991:Monitoring, Physiologic; D010538:Peritonitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D000067716:Point-of-Care Testing; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D012151:Resuscitation; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents
keywords: Abdominal sepsis; On-demand relaparotomy; Peritonitis; Planned relaparotomy; Treatment strategy