Surgical management of severe secondary peritonitis

Background: Despite advances in diagnosis, surgery, antimicrobial therapy a nd intensive care support, the mortality rate associated with severe second ary peritonitis remains unacceptably high. This article presents various su rgical treatment strategies for severe secondary peritonitis, emphasizing t he role of open management of the abdomen and planned relaparotomies. Methods: Material was identified from previous review articles, references cited in original papers and a Medline search of the literature. Results and conclusion: Surgical treatment of severe secondary peritonitis is highly demanding and very complex. The combination of improved surgical techniques, antimicrobial therapy and intensive care support has improved t he outcome of such peritonitis following perforation or anastomotic disrupt ion of the digestive tract, or infected necrotizing pancreatitis. However, aggressive surgical treatment strategies, such as open management of the ab domen and planned relaparotomies, may have reached their limits.