Surgery Blog for Surgeons

Second look: on-demand vs planned in patients with peritonitis

Every abdominal surgeon has patients with peritonitis. In severe cases, a "second look" should be planned. At least this is the common opinion. A group from Holland published a randomized trial about this topic. Surprisingly the results did not show higher morbidity in the "on-demand" group.

This is a surprise, due to the unavoidable human factor estimating the "demand" for relaparotomy. I've read only the abstract and therefore don't know how the demand was estimated but cannot imagine that the clinical evaluation by a surgeon was avoided. Therefore, considering the results of the trial, either it is really no problem to wait performing the "second look" or the "delusions" of the clinical evaluation are not significant. The latter could be the case if the indication for an operation is set generously, as it should be even in cases with a recurrence of severe peritonitis.

The conclusion is: "Patients in the on-demand relaparotomy group did not have a significantly lower rate of death or major peritonitis-related morbidity compared with the planned relaparotomy group but did have a substantial reduction in relaparotomies, health care utilization, and medical costs."