One Surgery Often Enough for Peritonitis

Study questions usefulness of secondary procedures.

By Randy Dotinga
HealthDay Reporter
Tuesday, August 21, 2007; 12:00 AM

Copyright © 2007 ScoutNews, LLC. All rights reserved.

TUESDAY, Aug. 21 (HealthDay News) -- Patients with a serious gastrointestinal infection known as peritonitis may not automatically need to undergo more operations beyond the first one, new research suggests.

In the United States, most surgeons choose to wait and see if they think patients need the extra surgery, said Dr. David Flum, a gastrointestinal surgeon at the University of Washington, who wrote a commentary about the study.

Until now, however, "there hasn't been a lot of evidence to guide that decision," he said.

The findings are published in the Aug. 22/29 issue of the Journal of the American Medical Association.

Peritonitis occurs when a hole develops in the intestines -- such as when the appendix bursts -- and allows bacteria to spill into the abdominal cavity, Flum said. Severe infection can result.

There's a high risk of death even after surgeons plug up the hole, he said, because bacteria remains and creates problems.

One approach has been to operate and then "keep taking them back to the operating room and washing out the abdominal cavity until they improve," Flum said. "Another strategy is to re-operate when the patient's body is giving you signs that it needs an operation."

In the new study, Dutch researchers at the Academic Medical Center, Amsterdam, examined the impact of each strategy on 225 patients. Only 42 percent of those in the "non-automatic-surgery" group actually went on to have a secondary operation, compared to 94 percent in the automatic-surgery group.

About a third of the patients in both groups died, and the researchers said there was no "significant difference" between their mortality rates.

However, patients who only underwent a second surgery when their doctors thought it necessary spent an average of seven days in intensive care versus 11 days for the other group. They also spent an average of 27 days in the hospital versus 35 days in the automatic-surgery cohort.

Meanwhile, "direct medical costs" were 23 percent less among those who didn't automatically have a subsequent surgery.