Surgical management of intra-abdominal infection: is there any evidence?

The aim of this review article was to look at the evidence supporting the surgical treatment of secondary bacterial peritonitis. Because the absolute necessity of adequate source control is not disputable and there is no question that peritoneal toilet (in whichever form) is mandatory, the main bulk of this manuscript is dedicated to the controversial issues of planned relaparotomy and laparostomy. We found little good evidence to support or refute the use of these modalities, but in the absence of evidence, one has to use experience and common sense. Ours suggest that planned relaparotomies combined with laparostomy represent, for the time being, the heaviest weaponry in the surgeon's mechanical armamentarium for the treatment of severe intra-abdominal infection. Even without level II evidence, we are convinced that these therapeutic modalities are life-saving in a well-selected group of patients. One has, however, to know when to stop and how not to harm.