New tendencies in the surgical treatment of diffuse peritonitis

Objective: We intend to analyze if additional treatment concepts are necess ary in any case as a part of the standard therapy next to the well establis hed principle of source control in the treatment of secondary peritonitis. Design: A treatment concept with early intervention, source control and ext ensive intraoperative lavage (20-301) should be evaluated as a standard pro cedure in a prospective survey. Additional treatment concepts will be appli ed only for special reason (on demand). Results: From 11/1993 to 9/1997 241 patients with diffuse peritonitis were treated with the concept mentioned above. Additional treatment concepts as continuous postoperative lavage (n = 20) and staged lavage (n = 4) were app lied as primary treatment in 24 patients only (10%). mainly for impossibili ty of source control and evisceration. Source control at the initial operat ion was possible in 216 patients (90%). Due to secondary evisceration 3 pat ients had to undergo laparostomy for staged lavage later. Severity of perit onitis was determined according to the Mannheim Peritonitis Index (median 2 6, range 15-43). The primary causes of peritonitis were perforation, leakag e and abscess after operation (n = 56), followed by diverticular (n = 42) a nd gastric or duodenal perforation (n = 39). The hospital mortality rate wa s 14% in the whole group, and the postoperative morbidity rate was 39%. Conclusions: Due to progress in intensive care and antibiotic treatment onl y a few patients (ca. 10%) need additional therapies such as postoperative or staged lavage. Surgical source control in combination with intraoperativ e lavage is sufficient in most of the patients with diffuse peritonitis.