Re-laparotomy for severe intra-abdominal infections

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.