[Secondary peritonitis]

There is some controversy regarding concepts currently propagated for an optimal surgical and antibiotic therapy in patients with secondary peritonitis and organ failure. It is not known whether the recent general progress in critical care ("Surviving Sepsis Campaign") has also improved outcome of this particular patient group.

MEDLINE, EMBASE and Cochrane databases were non-systematically searched from 1985 through January 2010 using the words "source control", "peritonitis", "operation", "critical care" and "antibiotics". We also present experiences in corresponding high risk patients from our institution.

The inability to obtain source control and an inadequate initial antibiotic therapy were -associated with a clearly higher mortality. De-pending on the initial intraoperative finding, planned and on demand relaparotomy do not conflict, but complement one another. The importance of the number of surgical revisions remains to be determined. Treatment after 2002 was associated with an improved prognosis. In contrast to source control, the mechanisms of increasing mortality with an inadequate initial antibiotic therapy remain controversial.

Source control is the most important determinant for acute survival and has to be placed on top of the therapeutic priority list. The number of revisions needed to obtain source control, however, does not vary with survival and cannot guide decisions on therapy withdrawal or continuation. The recent prognostic improvement indicates the efficiency of new adjuvant therapeutic measures in unselected surgical high-risk patients.