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Surgical management of intra-abdominal infection: is there any evidence?
1Cornell University College of medicine, New York, NY, USA. Mschein1@mindspring.com
Abstract:
The aim of this review article was to look at the evidence supporting the surgical treatment of secondary bacterial peritonitis. Because the absolute necessity of adequate source control is not disputable and there is no question that peritoneal toilet (in whichever form) is mandatory, the main bulk of this manuscript is dedicated to the controversial issues of planned relaparotomy and laparostomy. We found little good evidence to support or refute the use of these modalities, but in the absence of evidence, one has to use experience and common sense. Ours suggest that planned relaparotomies combined with laparostomy represent, for the time being, the heaviest weaponry in the surgeon's mechanical armamentarium for the treatment of severe intra-abdominal infection. Even without level II evidence, we are convinced that these therapeutic modalities are life-saving in a well-selected group of patients. One has, however, to know when to stop and how not to harm.
Insights
Surgical treatment for secondary bacterial peritonitis remains controversial. Planned relaparotomy and laparostomy, while lacking strong evidence, are suggested as life-saving interventions for severe intra-abdominal infections in select patients.
Area of Science:
- Surgical Gastroenterology
- Infectious Diseases
- Critical Care Medicine
Background:
- Secondary bacterial peritonitis is a severe intra-abdominal infection.
- Adequate source control and peritoneal toilet are essential but controversial aspects remain.
Purpose of the Study:
- To review evidence supporting surgical treatment for secondary bacterial peritonitis.
- To examine controversial surgical modalities: planned relaparotomy and laparostomy.
Main Methods:
- Review of existing literature on surgical management of secondary bacterial peritonitis.
- Analysis of evidence regarding planned relaparotomy and laparostomy.
Main Results:
- Limited high-quality evidence supports or refutes planned relaparotomy and laparostomy.
- Clinical experience suggests these are critical for severe intra-abdominal infections.
Conclusions:
- Planned relaparotomy with laparostomy is a powerful tool for severe intra-abdominal infections.
- These modalities can be life-saving in carefully selected patients.
- Judicious application and knowing when to cease intervention are crucial.