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Paradigm change in 30 years peritonitis treatment -- a review on source control
Abstract:
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.
Insights
Source control in peritonitis treatment lacks a uniform definition, hindering study comparability. Establishing standardized principles is crucial for improving patient survival rates in this critical surgical condition.
Area of Science:
- Surgical critical care
- Infectious disease management
- Clinical trial methodology
Background:
- Peritonitis poses significant surgical challenges despite advances in care.
- Improving survival rates necessitates a deeper understanding of peritonitis pathogenesis.
- Source control is a fundamental but inconsistently applied principle in peritonitis management.
Purpose of the Study:
- To evaluate the current understanding and application of source control in peritonitis research.
- To identify inconsistencies in defining and measuring source control effectiveness.
- To highlight the need for standardized source control evaluation in clinical studies.
Main Methods:
- A Medline search was conducted to identify studies on peritonitis and source control.
- Ninety studies were reviewed to assess information on source control evaluation.
- Analysis focused on definitions, methods, and outcomes related to source control.
Main Results:
- No uniform definition of source control was found across evaluated studies.
- Most peritonitis studies provide low-level evidence (Level 3-5).
- Surgical experience often substitutes for objective evidence in assessing source control success, with relaparotomy indicating failure.
Conclusions:
- Standardized definitions and evaluation methods for source control in peritonitis are urgently needed.
- Multi-center studies are required to establish evidence-based principles before initiating new treatment trials.
- Despite efforts, peritonitis mortality has only marginally decreased, underscoring the need for improved source control strategies.