Planned Relaparotomy vs Relaparotomy on Demand in the Treatment of Intra-abdominal Infections

T, Hau; Ohmann, Christian; Wolmershäuser, A.; Wacha, H.; Yang, Qin

doi:10.1001/archsurg.1995.01430110051009

Cited by 128 publications

(64 citation statements)

References 12 publications

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“…These patients may require several laparotomies to achieve the goals listed above. Therefore the surgeon should decide during the first or "index" laparotomy whether or not the patient may benefit from a reoperation, which could be done either as needed or through a planned/ scheduled reintervention [72][73][74][75][76]. Postoperative peritonitis has a very high mortality, ranging from 30% to 50%.…”

Section: Surgical Managementmentioning

confidence: 99%

Management of Peritonitis in the Critically Ill Patient

Ordóñez

Puyana

2006

Surgical Clinics of North America

108

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Section: Surgical Managementmentioning

confidence: 99%

Management of Peritonitis in the Critically Ill Patient

Ordóñez

Puyana

2006

Surgical Clinics of North America

108

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“…Conversely, indiscriminate use at "the end of the operative list," often by ever-changing members of junior staff, represents a recipe for disasters. 70 Management of Intra-Abdominal Abscess Erroneously, the term intra-abdominal abscess has been used as a synonym for peritonitis. This is not true because abscesses develop from effective host defenses and represent a relatively successful outcome of peritonitis.…”

Section: Operative Therapymentioning

confidence: 99%

Management of Secondary Peritonitis

Wittmann

Schein²,

Condon³

1996

Annals of Surgery

289

181

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ObjectiveThe authors review current definition, classification, scoring, microbiology, inflammatory response, and goals of management of secondary peritonitis. Summary Background DataDespite improved diagnostic modalities, potent antibiotics, modern intensive care, and aggressive surgical treatment, up to one third of patients still die of severe secondary peritonitis. Against the background of current understanding of the local and systemic inflammatory response associated with peritonitis, there is growing controversy concerning the optimal antibiotic and operative therapy, intensified by lack of properly conducted randomized studies. In this overview the authors attempt to outline controversies, suggest a practical clinical approach, and highlight issues necessitating further research. MethodThe authors review the literature and report their experience. ResultsThe emerging concepts concerning antibiotic treatment suggest that less-in terms of the number of drugs and the duration of treatment-is better. The classical single operation for peritonitis, which obliterates the source of infection and purges the peritoneal cavity, may be inadequate for severe forms of peritonitis; for the latter, more aggressive surgical techniques are necessary to decompress increased intra-abdominal pressure and prevent or treat persistent and recurrent infection. The widespread acceptance of the more aggressive and demanding surgical methods has been hampered by the lack of randomized trials and reportedly high associated morbidity rates. ConclusionsSepsis represents the host's systemic inflammatory response to bacterial peritonitis. To improve results, both the initiator and the biologic consequences of the peritoneal infective-inflammatory process should be addressed. The initiator may be better controlled in severe forms of peritonitis by aggressive surgical methods, whereas the search for methods to abort its systemic consequences is continuing.Intra-abdominal infections after spontaneous gastro-overview is to present the "state of the art" in the manintestinal perforation and those resulting from injuries agement of secondary peritonitis, to emphasize persistor complicating abdominal operations, still represent the ing controversies, and to identify the gaps in our knowl-"bread and butter" for surgeons. The purpose of this edge that require further study.

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“…There is consensus that the preferred strategy for mild peritonitis (APACHE-II [Acute Physiology and Chronic Health Evaluation] score of Յ10) is on-demand relaparotomy. 4,[12][13][14] Despite lacking evidence from randomized trials, overall support for the on-demand strategy even among patients with severe peritonitis is growing, 4,12,13,15,16 but both strategies are still used side-by-side in clinical practice. 17,18 The debate on which strategy is preferred dates back as far as the call for a randomized trial comparing both strategies by the Joint Working Party of the North American and European Surgical Infection Society in 1990.…”

mentioning

confidence: 99%