The authors analyzed evolution of therapeutic approaches for acute peritonitis with accent on abdominal drainage. A systematic review enrolled the PubMed, Scopus, Web of Science, eLibrary and Cochrane Library databases for the period 1980—2024. Methods of abdominal sanitation in acute peritonitis underwent through a long way of evolution from simple passive drainage to complex programmed interventions. Historically, various approaches have been used (from closed systems to open abdominal management with laparostomy). The middle of the 20^th century was marked by revolution of programmed relaparotomies, which made it possible to carry out scheduled revisions regardless of clinical status. Modern techniques include vacuum-assisted therapy, peritoneal lavage dialysis with antibacterial drugs, minimally invasive laparoscopic sanitation. Clinical studies demonstrate the advantages of a programmed approach over “on-demand” relaparotomies. Active drainage with cyclic washing provides not only mechanical cleansing, but also systemic detoxification. Choice of optimal tactics should be based on severity of peritonitis, clinical status of patients and capabilities of a particular hospital. Evolution of treatment for peritonitis is a bright example of triumph (victory) of scientific medicine over seemingly invincible disease. Words of G. Wegner are now perceived as evidence of the past era. Modern surgeons with appropriate knowledge, technologies and effective medicines successfully manage disease that inspired sacred fear a century and a half ago. However, peritonitis is still a serious challenge requiring high professionalism and multidisciplinary approach.