Katherine Mandell1, Saman Arbabi. 1. Department of Surgery, University of Washington and Harborview Medical Center, Seattle, Washington 98104, USA.
Abstract
BACKGROUND: The role of re-laparotomy in the management of intra-abdominal infection remains controversial. Two strategies have been used: Planned re-laparotomy or laparotomy on demand. METHODS: A review of the literature on this controversial subject was performed. RESULTS: Although in the past, planned re-laparotomy made sense for ensuring source control, improvements in imaging, intensive care therapy, and percutaneous interventions may have shifted the balance toward the laparotomy-on-demand strategy. Regardless of strategy, the rate of negative laparotomy remains high (>30%). Randomized trials are not available to provide definitive evidence, and clinical judgment continues to be the basis for decision making. CONCLUSIONS: Further work to develop more specific clinical tools and criteria to improve the accuracy of diagnosis may lead to use of the laparotomy-on-demand strategy rather than planned re-laparotomy. At this time, there is no good clinical evidence to support one strategy over the other from a mortality standpoint.
BACKGROUND: The role of re-laparotomy in the management of intra-abdominal infection remains controversial. Two strategies have been used: Planned re-laparotomy or laparotomy on demand. METHODS: A review of the literature on this controversial subject was performed. RESULTS: Although in the past, planned re-laparotomy made sense for ensuring source control, improvements in imaging, intensive care therapy, and percutaneous interventions may have shifted the balance toward the laparotomy-on-demand strategy. Regardless of strategy, the rate of negative laparotomy remains high (>30%). Randomized trials are not available to provide definitive evidence, and clinical judgment continues to be the basis for decision making. CONCLUSIONS: Further work to develop more specific clinical tools and criteria to improve the accuracy of diagnosis may lead to use of the laparotomy-on-demand strategy rather than planned re-laparotomy. At this time, there is no good clinical evidence to support one strategy over the other from a mortality standpoint.
Authors: Amani D Politano; Tjasa Hranjec; Laura H Rosenberger; Robert G Sawyer; Carlos A Tache Leon Journal: Am Surg Date: 2011-07 Impact factor: 0.688