Open abdomen An open abdomen (OA) procedure is the best way of implementing re-laparotomies. The role of the OA in the management of severe peritonitis has been a controversial issue. In 2007, a randomised study compared open and closed abdomens for the “on demand re-laparotomy” group in the treatment of severe peritonitis. The study was prematurely terminated following the treatment of 40 subjects

due to a significantly higher mortality rate in the open abdomen group compared to the temporarily closed abdomen group (55% vs. 30%). OA procedures were performed using only non-absorbable polypropylene mesh [99]. Although guidelines suggest not to routinely utilize the

open abdomen approach for selleck chemicals patients with severe intra-peritoneal contamination undergoing emergency laparotomy Selleckchem Wortmannin for intra-abdominal sepsis [100], LY333531 clinical trial OA has now been accepted as a strategy in treating intra-abdominal sepsis [101]. An OA approach in severe secondary peritonitis may be required for three different reasons, often used in combination: inadequate source control, severely deranged physiology (the operation is purposely abbreviated due to the severe physiological derangement and suboptimal local conditions for healing, and restoration of intestinal continuity is deferred to the second operation, i.e. the deferred anastomosis approach) [102], and prevention of abdominal compartment syndrome [103–105]. The rationale of the OA strategy in patients with severe abdominal sepsis refers to the cytokine release that is compartmentalized in the

peritoneal cavity. Inability to control or interrupt the local inflammatory response is associated with higher mortality rates in Fossariinae these patients. The attenuation of the local inflammatory response may be best achieved with mechanical control by reducing the load of cytokines and other inflammatory substances [106] and by preventing their production, thus removing the source itself. Sometimes more laparotomies are required to complete source control and OA allows the surgeon to perform subsequent planned laparotomies more efficiently. An interesting non-comparative descriptive case series [106] studied the inflammatory response in peritoneal exudate and plasma of patients undergoing planned re-laparotomy for severe secondary peritonitis. In septic patients undergoing re-laparotomy for severe peritonitis, endotoxin, tumour necrosis factor alpha, interleukin-1 and interleukin-6 levels, were higher in the peritoneal cavity then in plasma. When patients underwent re-laparotomy, the level of those cytokines was significantly decreased in survivors.