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Chirurgische Therapie der Peritonitis

Surgical therapy of peritonitis

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Zusammenfassung

Die Peritonitis ist trotz erheblicher Fortschritte eine ernstzunehmende therapeutische Herausforderung geblieben und bedingt mit einer hohen Letalität von bis zu 20% einen großen Anteil der Todesfälle durch chirurgische Infektionen. Prognostisch entscheidend bei der sekundären Peritonitis ist eine frühzeitige und effiziente Herdsanierung, kombiniert mit einer effektiven antimikrobiellen Therapie und einer guten supportiven intensivmedizinischen Therapie der Sepsis. Bei ca. 90% der Patienten gelingt die Herdsanierung im Rahmen einer einzigen Operation mit gründlicher Peritoneallavage. Bei nur 10% der Patienten ist eine operative Revision notwendig. Geplante Relaparotomien und die primäre Behandlung am offenen Abdomen sind mit erhöhter Morbidität verbunden und sind heute nur noch in Ausnahmefällen indiziert. Als Goldstandard sollte die definitive Fokussanierung mit Lavage in einem einzigen Eingriff angestrebt werden. Eine operative Revision sollte nur bei Bedarf erfolgen. Die antimikrobielle Therapie erfolgt zunächst mit einer breiten kalkulierten Antibiotikatherapie, die im Verlauf den mikrobiologischen Befunden angepasst wird. Die Sepsis bedarf einer standardisierten und modernen intensivmedizinischen Therapie.

Abstract

Despite significant progress the therapy of peritonitis remains challenging. With a mortality of up to 20% peritonitis is a predominant cause of death due to surgical infections. An early and efficient source control combined with effective antibiotic therapy and modern intensive care and sepsis therapy are definitive for the outcome and prognosis of secondary peritonitis. In approximately 90% of patients an effective source control can be achieved by one single operation with extensive peritoneal lavage. A reoperation is necessary in only about 10% of patients. The aggressive concepts of planned relaparotomy or open packing are associated with increased morbidity and are indicated only in rare cases. The gold standard is to attempt a definitive source control by one single operation. An operative revision should be performed only on demand. The antibiotic therapy should begin with a broadly calculated empirical therapy and should later be adapted to microbiological findings. The therapy of sepsis requires standardized and state of the art intensive care.

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  1. Klinik für Allgemeine, Viszerale und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    O. Strobel, J. Werner &  M.W. Büchler

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  1. O. Strobel
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  2. J. Werner
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  3. M.W. Büchler
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Correspondence to M.W. Büchler.

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Strobel, O., Werner, J. & Büchler, M. Chirurgische Therapie der Peritonitis. Chirurg 82, 242–248 (2011). https://doi.org/10.1007/s00104-010-2015-2

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