Re-laparotomy for severe intra-abdominal infections

The role of re-laparotomy in the management of intra-abdominal infection remains controversial. Two strategies have been used: Planned re-laparotomy or laparotomy on demand.

A review of the literature on this controversial subject was performed.

Although in the past, planned re-laparotomy made sense for ensuring source control, improvements in imaging, intensive care therapy, and percutaneous interventions may have shifted the balance toward the laparotomy-on-demand strategy. Regardless of strategy, the rate of negative laparotomy remains high (>30%). Randomized trials are not available to provide definitive evidence, and clinical judgment continues to be the basis for decision making.

Further work to develop more specific clinical tools and criteria to improve the accuracy of diagnosis may lead to use of the laparotomy-on-demand strategy rather than planned re-laparotomy. At this time, there is no good clinical evidence to support one strategy over the other from a mortality standpoint.