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August 22/29, 2007

Timing of Reoperation for Patients With Severe Peritonitis

Author Affiliations

Author Affiliation: Department of Surgery, University of Washington School of Medicine, Seattle.

JAMA. 2007;298(8):923-924. doi:10.1001/jama.298.8.923

Operations for severe intra-abdominal infection are intended to resolve the problem by dealing with the underlying pathology that caused the infection, or by addressing the intraperitoneal pathology caused by the disease (such as abscess), or both. This approach is called source control. Some of these initial surgical interventions predictably fail to achieve that goal and another intervention is required. Review of clinical series suggests that this occurs in 15% to 30% of unselected cases.1-8 Thirty years ago such reinterventions meant that another laparotomy was required, but in the interim, surgeons have learned that many cases, especially those involving intra-abdominal abscesses that follow a prior operation, can be managed with percutaneous drainage. This has been aided by increasingly available and increasingly accurate imaging technology. However, there remains a minority of cases that after failure of the initial operation require another laparotomy to resolve the intra-abdominal pathology.