THE ROLE OF PLANNED REOPERATIONS AND LAPAROSTOMY IN SEVERE INTRAABDOMINAL INFECTION - IS A PROSPECTIVE RANDOMIZED TRAIL POSSIBLE - DISCUSSION

The value of the aggressive management (laparostomy and planned relapa rotomies) of severe intra-abdominal infection has never been studied i n a well-designed, prospective, randomized trial. This communication a ttempts to outline the methodology for such a future study, emphasizin g the immense difficulties in conducting it properly. The trial design , the selection of patients, surgical considerations, supportive treat ment, end points, and the ''human factor'' are discussed. Only close c ooperation between a few dedicated surgeons, obsessively studying a la rge number of well-selected and stratified patients over years, could define more precisely the value of these surgical management modalitie s, at a time when the emphasis is shifting to the modification of host response.