This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Meta‐analysis of relaparotomy for secondary peritonitis. BJS 2002; 89: 1516-1524.
Published: 2nd December 2002
Authors: B. Lamme, M. A. Boermeester, J. B. Reitsma, C. W. Mahler, H. Obertop, D. J. Gouma et al.
Background
Planned relaparotomy and relaparotomy on demand are two frequently employed surgical treatment strategies for patients with abdominal sepsis.
Method
The available literature was evaluated to compare the efficacy of both surgical treatment strategies. A systematic search for studies comparing planned and on‐demand relaparotomy strategies in adult patients with secondary peritonitis was employed. Studies were reviewed independently for design features, inclusion and exclusion criteria, and outcomes. The primary outcome measure was in‐hospital mortality.
Results
No randomized studies were found; eight observational studies with a total of 1266 patients (planned relaparotomy, 286; relaparotomy on demand, 980) met the inclusion criteria and were included in the meta‐analysis. These eight studies were heterogeneous on clinical and statistical grounds (χ
2
= 40·7, d.f. = 7, P < 0·001). Using a random‐effects approach, the combined odds ratio for in‐hospital mortality was 0·70 (95 per cent confidence interval 0·27 to 1·80) in favour of the on‐demand strategy.
Conclusion
The combined results of observational studies show a statistically non‐significant reduction in mortality for the on‐demand relaparotomy strategy compared with the planned relaparotomy strategy when corrected for heterogeneity in a random‐effects model. Owing to the non‐randomized nature of the studies, the limited number of patients per study, and the heterogeneity between studies, the overall evidence generated by the eight studies was inconclusive. © 2002 British Journal of Surgery Society Ltd
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