[Therapy of peritonitis today. Surgical management and adjuvant therapy strategies]

Abstract

Acute necrotizing pancreatitis and fylecal or diffuse purulent peritonitis are the diseases primarily responsible for mortality due to surgical infections of the abdomen. The most recent figures indicate that a mortality rate of 50%-80% in this specialized treatment group is still a reality. Without doubt, surgical sanitation of the focus is the most important therapeutic measure. A generalized inflammation reaction has been regularly observed in nearly all patients within this disease category. Local surgical therapy has the greatest effect on prognosis. If the therapeutic goal is not reached with the first intervention, adjuvant surgical therapy is necessary. The different forms are continuous peritoneal lavage (CPL), open dorsoventral lavage, and relaparotomy or scheduled reoperation ("Etappenlavage"). Adjuvant medical treatments include TNF alpha and interleukin-1 synthesis inhibitors or antibodies. Unfortunately, clinical studies with these mediators have only been partly successful in the subgroups, so that a general clinical adjuvant treatment is not considered viable. The bacterial properties of taurolidine destroy the bacterial membrane and, at the same time, lead to cross-linking of the membrane components and functional proteins (LPS), so that a bactericidal effect and endotoxin reduction take place simultaneously. Both local and intravenous routes of administration can be used.