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When patients develop secondary peritonitis, does it pay to repeatedly operate for inspection, drainage, and peritoneal lavage of the abdominal cavity? In the United States, after performing an emergency laparotomy, most surgeons take a wait-and-see approach to performing an additional laparotomy (relaparotomy). But another strategy is to routinely perform one or more planned relaparotomies. Now, new research backs up the first approach.


Dutch researchers examined the effects of each strategy on 225 patients with severe secondary peritonitis. They randomly assigned half of the patients to receive automatic relaparotomy and the other half to "wait and see" if more surgery was needed.


Forty-two percent of patients in the "wait and see" group went on to have a relaparotomy, versus 94% in the automatic relaparotomy group. Thirty-one percent of the as-needed relaparotomies were negative, compared with 66% in the planned relaparotomy group. The mortality was similar in the two groups.


Patients in the wait-and-see group spent an average of 7 days in intensive care and 27 days in the hospital, compared with 11 and 35 days, respectively, for the automatic surgery group. In the as-needed group, costs were reduced 23% per patient.


The researchers concluded that although the as-needed relaparotomy strategy didn't significantly reduce mortality, it was associated with "substantial reduction in relaparotomies, health care utilization, and medical costs."




van Ruler O, et al., Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis, JAMA, August 22/29, 2007.