Severe Secondary Peritonitis: Reoperation Is Not Always Necessary

High morbidity and mortality rates among patients with secondary peritonitis (i.e., peritonitis linked to bowel perforation or other intra-abdominal catastrophes or to earlier abdominal surgery) have given rise to the strategy of scheduled surgical reexploration to identify and treat persistent foci of infection. With the advent of advanced imaging and directed percutaneous drainage techniques, is surgical reexploration always necessary? Researchers in the Netherlands addressed this question in a multicenter, prospective trial involving 232 adults diagnosed with severe secondary peritonitis between November 2001 and February 2005.

Participants were randomized to undergo planned serial relaparotomies every 36 to 48 hours until no evidence of …