Results of an aggressive surgical approach in the management of postoperative peritonitis.

Background: Treatment of postoperative peritonitis (POP) necessitates adequate control of the source of peritoneal contamination. For most patients, a surgical approach to this requires reoperation to restore intestinal continuity. The aim of this study was to audit our results for the surgical treatment of POP.

Methods: Medical records of patients treated for POP using a standardized surgical protocol in a dedicated intensive care unit at the Saint-Antoine Hospital between 1995 and 2003 were reviewed. The aim of the study was to consider the effectiveness of our surgical protocol in the eradication of all sources of peritoneal contamination in patients presenting with POP.

Results: There were 87 patients (34 women, mean age of 58.4 +/- 14.7) with a mean Acute Physiology and Chronic Health Evaluation II score of 17.2 +/- 4.7 (median 16.5, range 9-28). Eight patients died and there were complications in 60 patients. Nine patients of the 79 survivors either did not require or could not have an operation to restore intestinal continuity. Intestinal continuity was re-established through a parastomal incision for 26 patients, whereas 44 patients required a further laparotomy. Two patients of the latter group died and 11 patients had a complication. It was not possible to restore intestinal continuity at laparotomy for one patient.

Conclusion: An aggressive surgical approach, as reported in this series, including stoma formation whenever possible, diversion or intubation, provides effective control of the source of peritoneal contamination. Restoration of intestinal continuity is possible in most patients. The overall mortality rate for this treatment is 11.5%.