What is the role of surgery in the treatment of peritonitis and abdominal sepsis?

Updated: Jul 23, 2019
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Answer

Operative management addresses the need to control the infectious source and to purge bacteria and toxins. The type and extent of surgery depends on the underlying disease process and the severity of intra-abdominal infection. Definitive interventions to restore functional anatomy involve removing the source of the antimicrobial contamination and repairing the anatomic or functional disorder causing the infection. This is accomplished by surgical intervention. Occasionally, this can be achieved during a single operation; however, in certain situations, a second or a third procedure may be required. In some patients, definitive intervention is delayed until the condition of the patient improves and tissue healing is adequate to allow for a (sometimes) lengthy procedure.

Damage control surgery

Alternatively, over the past decade, in the setting of extensive abdominal inflammatory disease and septic shock, surgeons have used damage control operations (DCS) to temporarily drain the infection, quickly control the visceral leak, and defer any definitive repair until the patient has stabilized. DCS appears to be feasible for perforated diverticulitis and peritonitis or septic shock, whether or not patients are hemodynamically stable. [22, 23, 24]

See Surgical Approach to Peritonitis and Abdominal Sepsis for more information.


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