The site of the Media Sphera Publishers contains materials intended solely for healthcare professionals.
By closing this message, you confirm that you are a certified medical professional or a student of a medical educational institution.

Login
EN
+7 (495) 482-4118
+7 (495) 482-0604
+8 800 250-18-12
  • (toll-free number for subscriptions)
    Mon-Fri from 10 a.m. to 6 p.m.

  • © 1998-2025
+7 (495) 482-43-29
EN
All journals
Journal
Year
Year
Search result: 0

Nechay T.V.

Pirogov Russian National Research Medical University

Tyagunov A.E.

Pirogov Russian National Research Medical University

Li A.S.

Pirogov Russian National Research Medical University

Pozdnyakova A.A.

Pirogov Russian National Research Medical University

Yuldashev A.G.

Pirogov Russian National Research Medical University

Alieva Z.M.

Pirogov Russian National Research Medical University

The Mannheim Peritonitis Index cannot be routinely used to guide surgical decision-making for peritonitis

Authors:

Nechay T.V., Tyagunov A.E., Li A.S., Pozdnyakova A.A., Yuldashev A.G., Alieva Z.M.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2025;(8): 97‑109

DOI: 10.17116/hirurgia202508197

Read: 763 times

Download PDF (RU)
Contact the author
Table of contents

THE MANNHEIM PERITONITIS INDEX CANNOT BE ROUTINELY USED TO GUIDE SURGICAL DECISION-MAKING FOR PERITONITIS
THE MANNHEIM PERITONITIS INDEX CANNOT BE ROUTINELY USED TO GUIDE SURGICAL DECISION-MAKING FOR PERITONITIS

To cite this article:

Nechay TV, Tyagunov AE, Li AS, Pozdnyakova AA, Yuldashev AG, Alieva ZM. The Mannheim Peritonitis Index cannot be routinely used to guide surgical decision-making for peritonitis. Pirogov Russian Journal of Surgery. 2025;(8):97‑109. (In Russ.)
https://doi.org/10.17116/hirurgia202508197

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)
МСФ на ЯМ
Использование инфографики авторами научных работ
Close metadata
Recommended articles:
The role of some inflammatory markers in diagnosis of acute peri­tonitis in patients with HIV infe­ction. Piro­gov Russian Journal of Surgery. 2024;(12):29-37
Pulmonary distress syndrome in urgent surgery: A concept, pathogenesis, and fundamentals of treatment. Piro­gov Russian Journal of Surgery. 2025;(2):77-85
Fascial abdo­minal closure is a key factor of effe­ctive VAC-assisted lapa­rostomy. Piro­gov Russian Journal of Surgery. 2025;(4):61-70
Abstract:

OBJECTIVE

To evaluate the evidence base of the Mannheim Peritonitis Index (MPI) for choice of relaparotomy (programmed vs on-demand) in severe peritonitis.

MATERIAL AND METHODS

The study was carried out in 3 stages.

1. MPI-based assessment of evidence base of national guidelines «Peritonitis» regarding the choice of relaparotomy (programmed vs on-demand).

2. Statements and recommendations of current foreign guidelines on MPI-based choice of tactics for peritonitis.

3. Systematic review of evidence base of studies that used MPI to determine surgical tactics.

RESULTS

The studies listed in national guidelines do not provide evidence of feasibility of MPI as a tool for determining tactics. This index is not mentioned in 3 out of 7 foreign recommendations on abdominal surgical infection. In other recommendations with moderate level of recommendations and low level of evidence, MPI is indicated as a tool for predicting mortality. In 7 retrospective studies not included in recommendations, there was no evidence for advisability of MPI to determine surgical tactics.

CONCLUSION

There is currently no evidence base for MPI in choosing programmed or on-demand relaparotomy in case of severe peritonitis. Further high-evidence studies are required to find significant criteria.

Keywords:

peritonitis
Mannheim peritonitis index
MPI
programmed relaparotomy

Authors:

Nechay T.V.

Pirogov Russian National Research Medical University

Tyagunov A.E.

Pirogov Russian National Research Medical University

Li A.S.

Pirogov Russian National Research Medical University

Pozdnyakova A.A.

Pirogov Russian National Research Medical University

Yuldashev A.G.

Pirogov Russian National Research Medical University

Alieva Z.M.

Pirogov Russian National Research Medical University

Received:

10.12.2024

Accepted:

18.12.2024

Close metadata

References:

  1. Clements TW, Tolonen M, Ball CG, Kirkpatrick AW. Secondary Peritonitis and Intra-Abdominal Sepsis: An Increasingly Global Disease in Search of Better Systemic Therapies. Scand J Surg. 2021;110(2):139-149.  https://doi.org/10.1177/1457496920984078
  2. Lamme B, Boermeester MA, Reitsma JB, Mahler CW, Obertop H, Gouma DJ. Meta-analysis of relaparotomy for secondary peritonitis. Br J Surg. 2002;89(12):1516-1524. https://doi.org/10.1046/j.1365-2168.2002.02293.x
  3. Van Ruler O, Mahler CW, Boer KR, Reuland EA, Gooszen HG, Opmeer BC, De Graaf PW, Lamme B, Gerhards MF, Steller EP, Olivier van Till JW, De Borgie CJAM, Gouma DJ, Reitsma JB, Boermeester MA, Dutch Peritonitis Study Group F the. Comparison of On-Demand vs Planned Relaparotomy Strategy in Patients With Severe Peritonitis. JAMA. 2007;298(8):865-872.  https://doi.org/10.1001/jama.298.8.865
  4. Sigua BV, Zemlyanoy VP, Kotkov PA, Ignatenko VA. Comparison of the effectiveness of planned and «on-demand» relaparotomies in patients with secondary diffuse peritonitis (review of literature). Vestnik khirurgii imeni Grekova II. 2021;180(6):96-104. (In Russ.). https://doi.org/10.24884/0042-4625-2021-180-6-96-104
  5. Hau T, Ohmann C, Wolmershäuser A, Wacha H, Yang Q. Planned Relaparotomy vs Relaparotomy on Demand in the Treatment of Intra-abdominal Infections. Arch Surg. 1995;130(11):1193-1196. discussion 1196-7.  https://doi.org/10.1001/archsurg.1995.01430110051009
  6. Opmeer BC, Boer KR, Van Ruler O, Reitsma JB, Gooszen HG, De Graaf PW, Lamme B, Gerhards MF, Steller EP, Mahler CM, Obertop H, Gouma DJ, Bossuyt PM, De Borgie CA, Boermeester MA. Costs of relaparotomy on-demand versus planned relaparotomy in patients with severe peritonitis: an economic evaluation within a randomized controlled trial. Critical Care. 2010;14(3):97.  https://doi.org/10.1186/cc9032
  7. https://xn----9sbdbejx7bdduahou3a5d.xn--p1ai/stranica-pravlenija/klinicheskie-rekomendaci/urgentnaja-abdominalnaja-hirurgija/peritonit-2023.html
  8. Национальные клинические рекомендации по острому перитониту 2017 г. Ссылка активна на 17.11.2024. https://общество-хирургов.рф/stranica-pravlenija/unkr/urgentnaja-abdominalnaja-hirurgija/ostryi-peritonit.html
  9. Linder MM, Wacha H, Feldmann U, Wesch G, Streifensand RA, Gundlach E. Der Mannheimer Peritonitis-Index. Ein Instrument zur intraoperativen Prognose der Peritonitis. Chirurg. 1987;58(2):84-92. (In Germ.). https://doi.org/10.1007/978-3-642-73008-5_6
  10. Függer R, Rogy M, Herbst F, Schemper M, Schulz F. Validation study of the Mannheim Peritonitis Index. Chirurg. 1988;59(9):598-601. (In Germ.).
  11. Malik AA, Wani KA, Dar LA, Wani MA, Wani RA, Parray FQ. Mannheim Peritonitis Index and APACHE II — prediction of outcome in patients with peritonitis. Ulus Travma Acil Cerrahi Derg. 2010;16(1):27-32. 
  12. Muralidhar VA, et al. Efficacy of Mannheim Peritonitis Index (MPI) Score in Patients with Secondary Peritonitis. J Clin Diagn Res. 2014;8(12):1-3.  https://doi.org/10.7860/jcdr/2014/8609.5229
  13. Ramteke H, Deshpande SG, Bhoyar R. The Role of the Mannheim Peritonitis Index for Predicting Outcomes in Patients With Perforation Peritonitis in a Rural Hospital in India. Cureus. 2023;15(3):36620. https://doi.org/10.7759/cureus.36620
  14. Billing A, Fröhlich D, Schildberg FW. Prediction of outcome using the Mannheim peritonitis index in 2003 patients. J Br Surg. 1994;81(2):209-213.  https://doi.org/10.1002/bjs.1800810217
  15. Budzyński P, Dworak J, Natkaniec M, Pędziwiatr M, Major P, Migaczewski M, Matłok M, Budzyński A. The usefulness of the Mannheim Peritonitis Index score in assessing the condition of patients treated for peritonitis. Pol Przegl Chir. 2015;87(6):301-306. 
  16. Omel’yanovskii V.V., Sukhorukikh O.A., Luk»yantseva D.V. i dr. Metodicheskie rekomendatsii po provedeniyu otsenki nauchnoi obosnovannosti vklyuchaemoi v klinicheskie rekomendatsii informatsii. Moskva: Federal’noe gosudarstvennoe byudzhetnoe uchrezhdenie «Tsentr ehkspertizy i kontrolya kachestva meditsinskoi pomoshchi» Ministerstva zdravookhraneniya Rossiiskoi Federatsii; 2019. (In Russ.). https://webmed.irkutsk.ru/doc/pdf/recmethod.pdf
  17. Order of the Ministry of Health of the Russian Federation of February 28, 2019 No. 103n «On approval of the procedure and terms for the development of clinical guidelines, their revision, the standard form of clinical guidelines and requirements for their structure, composition and scientific validity of the information included in clinical guidelines.» Link active as of 01.12.2024  https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/052/500/original/%D0%9F%D1%80%D0%B8%D0%BA%D0%B0%D0%B7_%D0%9C%D0%B8%D0%BD%D0%B8%D1%81%D1%82%D0%B5%D1%80%D1%81%D1%82%D0%B2%D0%B0_%D0%B7%D0%B4%D1%80%D0%B0%D0%B2%D0%BE%D0%BE%D1%85%D1%80%D0%B0%D0%BD%D0%B5%D0%BD%D0%B8%D1%8F_%D0%A0%D0%A4_%D0%BE%D1%82_28_%D1%84%D0%B5%D0%B2%D1%80%D0%B0%D0%BB%D1%8F_2019_%D0%B3_N_103%D0%BD_%D0%9E%D0%B1_%D1%83%D1%82%D0%B2%D0%B5%D1%80%D0%B6%D0%B4%D0%B5%D0%BD%D0%B8.pdf?1603289471
  18. Chandler J, Cumpston M, Li T, Page M. Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Training; 2021. Available from: https://training.cochrane.org/handbook/current
  19. Bityukov SL, Demydenko VV. Efficiency of using the Mannheim peritonitis index in predicting complications and mortality in case of diffuse peritonitis. Morphological almanac named after V.G. Koveshnikov. 2019;17(3):14-18. (In Russ.).
  20. Basnet RB, Sharma VK. Evaluation of predictive power of Mannheim Peritonitis Index. PMJN. 2010;8(2):10-13. 
  21. Budamala S, Penugonda A, Prakash GV, Ramaniah NV, et al. Evaluation of Various Prognostic Factors in Perforative Peritonitis Management. J Evidence based Med Healthcare. 2015;2(38):6027-6035.
  22. Dani T, Ramachandra L, Nair R, Sharma D. Evaluation of prognosis in patients with perforation peritonitis using Mannheim’s peritonitis index. Int J Scie Res Publ. 2015;5(5):4-39. 
  23. Robledo FA, Luque-de-León E, Suárez R, Sánchez P, De-la-Fuente M, Vargas A, Mier J. Open versus Closed Management of the Abdomen in the Surgical Treatment of Severe Secondary Peritonitis: A Randomized Clinical Trial. Surg Infect. 2007;8(1):63-72.  https://doi.org/10.1089/sur.2006.8.016
  24. Sartelli M, et al. WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections. World J Emerg Surg. 2021;16(1):49.  https://doi.org/10.1186/s13017-021-00387-8
  25. Coccolini F, et al. The open abdomen in trauma and non-trauma patients: WSES guidelines. World J Emerg Surg. 2018;13:7.  https://doi.org/10.1186/s13017-018-0167-4
  26. Coccolini F, et al. Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines. World J Emerg Surg. 2023;18(1):41.  https://doi.org/10.1186/s13017-023-00509-4
  27. Diaconescu B, et al. The Bucharest ESTES consensus statement on peritonitis. Eur J Trauma Emerg Surg. 2020;46(5):1005-1023. https://doi.org/10.1007/s00068-020-01338-9
  28. Xiuwen Wu, et al. Diagnosis and Management of Intraabdominal Infection: Guidelines by the Chinese Society of Surgical Infection and Intensive Care and the Chinese College of Gastrointestinal Fistula Surgeons. Clin Infect Dis. 2020;71(4):337-362.  https://doi.org/10.1093/cid/ciaa1513
  29. Montravers P, et al. Guidelines for management of intra-abdominal infections. Anaesth Crit Care Pain Med. 2015;34(2):117-130.  https://doi.org/10.1016/j.accpm.2015.03.005
  30. Mazuski JE, et al. The Surgical Infection Society (SIS) revised guidelines on the management of intra-abdominal infection. Surg Infect (Larchmt). 2017;18(1):1-76.  https://doi.org/10.1089/sur.2016.261
  31. Van Ruler O, Lamme B, De Vos R, Obertop H, Reitsma J, Boermeester M. Decision Making for Relaparotomy in Secondary Peritonitis. Digest Surg. 2008;25(5):339-346.  https://doi.org/10.1159/000158911
  32. Koperna T, Schulz F. Relaparotomy in Peritonitis: Prognosis and Treatment of Patients with Persisting Intraabdominal Infection. World J Surg. 2000;24(1):32-37.  https://doi.org/10.1007/s002689910007
  33. Tellor B, Skrupky LP, Symons W, High E, Micek ST, Mazuski JE. Inadequate Source Control and Inappropriate Antibiotics are Key Determinants of Mortality in Patients with Intra-Abdominal Sepsis and Associated Bacteremia. Surg Infect. 2015;16(6):785-793.  https://doi.org/10.1089/sur.2014.166
  34. Hutchins RR, Gunning MP, Lucas DN, Allen‐Mersh TG, Soni NC. Relaparotomy for suspected intraperitoneal sepsis after abdominal surgery. World J Surg. 2004;28(2):137-141.  https://doi.org/10.1007/s00268-003-7067-8
  35. Coccolini F, Perrina D, Ceresoli M, Kluger Y, Kirkpatrick A, Sartelli M, Ansaloni L, Catena F. Open abdomen and age; results from IROA (International Register of Open Abdomen). Am J Surg. 2020;220(1):229-236.  https://doi.org/10.1016/j.amjsurg.2019.11.022
  36. Sartelli M, Viale P, Koike K, et al. WSES consensus conference: Guidelines for first-line management of intra-abdominal infections. World J Emerg Surg. 2011;6:2.  https://doi.org/10.1186/1749-7922-6-2
  37. Van Ruler O, Kiewiet JJ, Boer KR, Lamme B, Gouma DJ, Boermeester MA, Reitsma JB. Failure of available scoring systems to predict ongoing infection in patients with abdominal sepsis after their initial emergency laparotomy. BMC Surg. 2011;11(1):1-7.  https://doi.org/10.1186/1471-2482-11-38
  38. Paugam-Burtz C, Dupont H, Marmuse J-P, Chosidow D, Malek L, Desmonts J-M, Mantz J. Daily organ-system failure for diagnosis of persistent intra-abdominal sepsis after postoperative peritonitis. Intensive Care Med. 2002;28(5):594-598.  https://doi.org/10.1007/s00134-002-1250-5
  39. Akbayir O, Ulukent SC, Guraslan H, Seyhan NA, Gunkaya OS, Cingillioglu B, Akturk E, Yuksel IT. Open abdomen technique used in complications of major gynecological oncology surgery. J Obstet Gynaecol Res. 2022;48(7):1904-1912. https://doi.org/10.1111/jog.15296
  40. Krylov NN, Babkin OV, Babkin DO. Mannheim peritonitis index as a surgical criterion for perforative duodenal ulcer. Pirogov Russian Journal of Surgery. 2016;(7):18-22. (In Russ.). https://doi.org/10.17116/hirurgia2016718-22
  41. Viehl CT, Kraus R, Zürcher M, Ernst T, Oertli D, Kettelhack C. The Acute Physiology and Chronic Health Evaluation II score is helpful in predicting the need of relaparotomies in patients with secondary peritonitis of colorectal origin. Swiss Med Wkly. 2012;142:13640. https://doi.org/10.4414/smw.2012.13640
  42. Plotkin LL, Parfyonov OV, Gamza VN. Estimation of risk of repeated operative interventions of patients with a widespread peritonitis. Ural Medical Journal. 2013;3(108):106-109. (In Russ.).
  43. Sigua BV, Zemlyanoy VP, Petrov SV, Ignatenko VA, Kotkov PA. Surgical Aspects of the Treatment of Patients With Generalized Peritonitis. Russian Sklifosovsky Journal «Emergency Medical Care». 2021;10(1):58-65. (In Russ.). https://doi.org/10.23934/2223-9022-2021-10-1-58-65
  44. Miziev I.A., Misrokov M.M., Dabagov O.Yu., Ahkubekov R.A., Oshroev M.M. Choosing surgical technique for diffuse peritonitis. Annaly khirurgii. Russian journal of surgery. 2008;6:45-47. (In Russ.).
  45. Miller AS, Boyce K, Box B, Clarke MD, Duff SE, Foley NM, Guy RJ, Massey LH, Ramsay G, Slade DAJ, Stephenson JA, Tozer PJ, Wright D. The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery. Colorectal Dis. 2021;23(2):476-547.  https://doi.org/10.1111/codi.15503
  46. Basu A, Pai DR. Early elevation of intra-abdominal pressure after laparotomy for secondary peritonitis: a predictor of relaparotomy? World J Surg. 2008;32(8):1851-1856. https://doi.org/10.1007/s00268-008-9605-x
  47. Bini R, Ferrari G, Aprà F, Viora T, Leli R, Cotogni P. Peritoneal lactate as a potential biomarker for predicting the need for reintervention after abdominal surgery. J Trauma Acute Care Surg. 2014;77(2):376-380.  https://doi.org/10.1097/ta.0000000000000302
  48. Assfalg V, Wolf P, Reim D, Hüser N, Hellbrügge G, Matevossian E, Friess H, Holzmann B, Emmanuel KL, Novotny AR. Procalcitonin ratio and on-demand relaparotomy for septic peritonitis: validation of the focus index (FI). Surg Today. 2016;46(5):603-612.  https://doi.org/10.1007/s00595-015-1226-z
  49. Holzheimer RG, Gathof B. Re-operation for complicated secondary peritonitis — how to identify patients at risk for persistent sepsis. Eur J Med Res. 2003;8(3):125-134. 
  50. Kim JJ, Liang MK, Subramanian A, Balentine CJ, Sansgiry S, Awad SS. Predictors of relaparotomy after nontrauma emergency general surgery with initial fascial closure. Am J Surg. 2011;202(5):549-552.  https://doi.org/10.1016/j.amjsurg.2011.06.023
  51. Atema JJ, Ram K, Schultz MJ, Boermeester MA. External Validation of a Decision Tool To Guide Post-Operative Management of Patients with Secondary Peritonitis. Surg Infect (Larchmt). 2017;18(2):189-195.  https://doi.org/10.1089/sur.2016.017
  52. Savel`ev VS, Gel`fand BR, Filimonov MI, Podachin PV, Sergeeva NA. Criteria for the selection of effective surgical treatment of widespread peritonitis. Annaly khirurgii. Russian journal of surgery. 2013;(2):48-54. (In Russ.).
  53. Sartelli M, Catena F, Di Saverio S, et al. Current concept of abdominal sepsis: WSES position paper. World J Emerg Surg. 2014;9(1):22.  https://doi.org/10.1186/1749-7922-9-22
  54. Koperna T, Schulz F. Prognosis and treatment of peritonitis. Do we need new scoring systems? Arch Surg. 1996;131(2):180-186.  https://doi.org/10.1001/archsurg.1996.01430140070019
Contact the author
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.

Email Confirmation

An email was sent to test@gmail.com with a confirmation link. Follow the link from the letter to complete the registration on the site.

Email Confirmation

Contact us
If you have any questions, complaints or suggestions, please use this feedback form.
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.
Submit Application

You can become an author of one of our magazines, send a request and we will consider it in during the day.

Name
Phone
E-mail
Message
Login
Registration
E-mail
Password
Forgot Password?

Log in to the site using your account in one of the services

Password recovery
E-mail
Login
Register

We use cооkies to improve the performance of the site. By staying on our site, you agree to the terms of use of cооkies. To view our Privacy and Cookie Policy, please. click here.