Invited Commentary

  • Ronald V. Maier


The biological rationale for source control is, indeed, a fascinating and challenging concept. Dr. Dunn in this introductory chapter has concisely iterated the major concepts and beliefs underlying the rationale for efficient and effective source control of infectious processes. A major implication of this overview is that primary surgical source control remains unproven by prospective randomized controlled trials (RCTs) and, as such, is in large part an empiric act of faith. In contrast, as cogently stated, there have been seemingly unlimited prospective randomized trials investigating the impact of improvements in the secondary components of source control, such as antibiotic selection. However, these secondary issues are not the critical issue in most cases. In fact, the ethical acceptability of such trials is based on the presumed near equivalence of expected outcomes. In most cases, adequate surgical debridement or mechanical elimination of infected tissues or contaminated devices will suffice for a cure. Unfortunately, there have been very limited Level I prospective RCTs to clearly define the true contribution and importance of mechanical source control to subsequent morbidity and mortality. In addition, the extent of debridement and approach (e.g., open vs. closed) have been minimally investigated. And, because of the ethical dilemma inherent in the use of a control group when mortality is the end point in these potential trials, they are unlikely to ever be performed.


Necrotizing Fasciitis Source Control Intraabdominal Infection Infectious Focus Prospective RCTs 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Platell C, Hall J (1998) What is the role of mechanical bowel preparation in patients undergoing colorectal surgery? Dis Colon Rectum 41:875–882PubMedCrossRefGoogle Scholar
  2. 2.
    Clarke JS, Condon RE, Bartlett JG, Gorbach SL, Nichols RL, Ochi S (1977) Preoperative oral antibiotics reduce septic complications of colon operations: results of prospective, randomized, double-blind clinical study. Ann Surg 186:251–259PubMedCrossRefGoogle Scholar
  3. 3.
    Condon RE, Bartlett JG, Nichols RL, Schulte WJ, Gorbach SL, Ochi S (1979) Preoperative prophylactic cephalothin fails to control septic complications of colorectal operations: results of controlled clinical trial. A Veterans Administration cooperative study. Am J Surg 137:68–74PubMedCrossRefGoogle Scholar
  4. 4.
    Weaver M, Burdon DW, Youngs DJ, Keighley MR (1986) Oral neomycin and erythromycin compared with single-dose systemic metronidazole and ceftriaxone prophylaxis in elective colorectal surgery. Am J Surg 151:437–442PubMedCrossRefGoogle Scholar
  5. 5.
    Ambrosetti P, Morel P (1998) Acute left-sided colonic diverticulitis: diagnosis and surgical indications after successful conservative therapy of first time acute diverticulitis. Zentralbl Chir 123:1382–1385PubMedGoogle Scholar
  6. 6.
    Nitecki S, Assalia A, Schein M (1993) Contemporary management of the appendiceal mass. Br J Surg 80:18–20PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2003

Authors and Affiliations

  • Ronald V. Maier

There are no affiliations available

Personalised recommendations