Prospective multi-centre comparative study of the treatment of peritonitis. Quality control in the treatment of severe intra-abdominal infections

Despite all the efforts made in the areas of intensive care and surgery, se vere peritonitis remains a feared condition that is associated with a high mortality rate. Severe abdominal infections are accompanied by a high level of endotoxin production, resulting in the so-called systemic inflammatory response syndrome (SIRS), which is often complicated by multiple organ fail ure. In addition to the surgical elimination of the source of the infection , the removal of the endotoxin is of prime importance. The aim of surgical treatment of peritonitis is, in the first instance, the elimination of the bacterial contamination and prevention or reduction - if possible - of fibr in formation. Attempts to block the cascade of mediators by pharmacological means have so far proved ineffective. For more than 10 years, therefor, va rious forms of abdominal lavage have been of vital importance in reducing b acterial contamination and aiding the healing process after successful surg ical elimination of the focus of infection. A watertight temporary closure for the abdominal wall (TAC(R)) was developed, which makes possible the con tinuous irrigation of the abdominal cavity. At the same time, it also gives the oedematous abdominal organs room to expand without the constraints oth erwise imposed by the abdominal wall. This concept has extended the spectru m of surgical options, and we believe that, as a result, a reduction in the mortality rate associated with severe peritonitis with sepsis (MPI > 26) c an be achieved. To investigate this hypothesis, a multi-centre study is pre sently being conducted. In a prospective parallel-group study, patients are randomized to either programmed etappenlavage with the Ethizip(R) or to op en dorsoventral interval therapy using the TAC(R). The patients are stratif ied on the basis of APACHE II and MPI, and the post-operative course is doc umented in a standardized manner. As secondary objectives, the study also a ims to clarify the question as to whether the new therapeutic concept is al so capable of reducing the number of revisions necessary, the duration of i ntensive care treatment, and the length of hospitalization, as also of abbr eviating antibiotic treatment. Since it is being done under controlled cond itions, and a uniform documentation is being used, the study represents a m ajor contribution to quality control in the field of surgical treatment of peritonitis.