Comparing Two Surgical Options -- MEDICA - World Forum for Medicine

Secondary peritonitis is an inflammation involving the tissue that lines the abdominal wall and covers the intra-abdominal organs. It has a high rate of death (20 -60 percent) and high rate of illness due to the development of sepsis with multiple organ failure. “Health care utilization due to secondary peritonitis is extensive, with operations to eliminate the source of infection (laparotomy) and multidisciplinary care in the intensive care unit setting,” the authors of the study write.

After the initial emergency laparotomy, relaparotomy may be necessary to eliminate persistent peritonitis or new infections. “There are two widely used strategies: relaparotomy when the patient’s condition demands it (‘on-demand’) and planned relaparotomy. In the planned strategy, a relaparotomy is performed every 36 to 48 hours for inspection, drainage, and peritoneal lavage of the abdominal cavity until findings are negative for ongoing peritonitis.”

Researchers at the Academic Medical Center, Amsterdam conducted a randomized trial comparing the on-demand strategy with the planned relaparotomy strategy following initial emergency surgery for patients with severe secondary peritonitis. A total of 232 patients (116 on-demand and 116 planned) were included.

The researchers found that there was no significant difference in death alone (29 percent on-demand versus 36 percent planned) or illness alone (40 percent on-demand versus 44 percent planned). Patients in the on-demand group had shorter median intensive care unit stays (seven versus eleven days) and shorter median hospital stays (27 versus 35 days). Direct medical costs per patient were reduced by 23 percent using the on-demand strategy.

“This randomized trial found that compared with planned relaparotomy, the on-demand strategy did not result in statistically significant reductions in the primary outcomes of death or major peritonitis-related morbidity but did result in significant reductions in the secondary outcomes of health care utilization, including the number of relaparotomies, the use of percutaneous drainage, and hospital and ICU stay,” the authors write.; Source: American Medical Association