Interventional management of abdominal sepsis: when and how.

BACKGROUND: To decide "how and when to treat intra-abdominal infection" is one of the most important challenges for surgeons interested in abdominal sepsis. The minimally invasive approach to intra-abdominal infection, both diagnostic and therapeutic, has gained great popularity in recent years: the cause of infection is assessed as soon as possible by means of sophisticated radiography and minimally invasive surgery, patients with intra-abdominal infection are treated with the least surgical injury in order not to aggravate the systemic response ("second hit"), and clinicians rely on clinical scoring combined with new imaging techniques to decide for reintervention. In some patients with severe intra-abdominal infection damage control followed by a few planned relaparotomies seems necessary to provide a solid basis for the patient to start recovering. Paying close attention in these patients to maximal support vital systems and preventing local complications seems crucial for their eventual prognosis. DISCUSSION: In this context we discuss important surgical topics such as primary resection and anastomosis in perforated diverticulitis, planned relaparotomy vs. relaparotomy "on demand," intra-abdominal hypertension, and primary and delayed abdominal wall closure techniques after operation for severe intra-abdominal infection.