[Surgical treatment of secondary peritonitis: A continuing problem. German version]

Area of Science:

• Surgical critical care
• Abdominal surgery
• Peritonitis management

Background:

• Secondary peritonitis presents significant mortality and morbidity challenges.
• Source control via surgery, antimicrobial therapy, and intensive care are key treatments.
• Relaparotomy on demand (ROD) emerged as a preferred strategy in a randomized trial.

Purpose of the Study:

• To evaluate the effectiveness and implementation challenges of relaparotomy on demand (ROD) for secondary peritonitis.
• To assess the role of diagnostic tools and monitoring in ROD.
• To identify areas for future research in peritonitis management.

Main Methods:

• Review of a randomized clinical trial comparing ROD with other strategies.
• Analysis of factors influencing ROD implementation, including patient selection and monitoring.
• Evaluation of diagnostic tools like computed tomography (CT) in the postoperative phase.

Main Results:

• ROD is a viable treatment strategy for secondary peritonitis.
• Effective ROD requires intensive monitoring and robust diagnostic capabilities.
• Patient selection and the use of reliable monitoring tools are critical but often lacking.
• A relaparotomy decision tool shows reasonable accuracy for predicting peritonitis and guiding CT use.
• The utility of CT in the early postoperative period remains uncertain.

Conclusions:

• Successful ROD implementation hinges on continuous patient monitoring and accessible diagnostic services.
• Barriers to ROD include inadequate patient selection and a lack of simple, reliable monitoring tools.
• Further research should explore the benefits of CT and refine bedside prediction tools for optimal patient selection in secondary peritonitis.
• Multidisciplinary collaboration is essential for optimizing interventions in peritonitis management.