• S Pauly, F P Schulze, O Horstmann, H Becker, M Grade, and M Ghadimi.
• Centrum für Muskuloskeletale Chirurgie, Charité Universitätsmedizin Berlin, Deutschland.
• Zentralbl Chir. 2013 Jun 1; 138 (3): 289-94.

BackgroundDespite modern surgical and intensive-care concepts, diffuse peritonitis remains a major source of high morbidity and mortality. The aim of this study was to critically evaluate the value of relaparotomy on demand (ROD) for patients with diffuse peritonitis.Patients And ResultsIn a retrospective analysis, the clinical course of 231 patients with diffuse peritonitis was analysed. The mean Mannheim Peritonitis Index (MPI) was 25.3. Overall lethality in this cohort was 14.3 %. In 214 patients, source control was successful during the index operation, and these patients were treated according to an on-demand strategy. For 178 of these patients, there was no demand for a relaparotomy, whereas 36 of these patients required further surgical interventions. Lethality for these subgroups was 9 % (no relaparotomy) and 27 % (relaparotomy), respectively.ConclusionsThis retrospective analysis confirms that an on-demand strategy is reasonable and feasible after successful source control and lavage. However, it still remains of clinical importance to identify parameters that may assist in selecting those patients who require a relaparotomy.Georg Thieme Verlag KG Stuttgart · New York.

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