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Meanwhile, "direct medical costs" were 23 percent less among those who didn't automatically have a subsequent surgery.

"It doesn't like look there's a huge difference in survival," Flum said. "But the approach with fewer operations and less cost would be the preferred one."

Dr. E. Patchen Dellinger, chief of the division of general surgery at the University of Washington, Seattle, said he hopes that questions about the validity of automatic re-operation are now settled.

"An area that could use study is how long antibiotics should be continued in the treatment of peritonitis," said Dellinger, who also wrote a journal commentary on the Dutch study. "Currently, I believe that many [peritonitis] patients get antibiotics for far longer than needed."

More information

There's more on peritonitis at the University of Maryland.

SOURCES: David R. Flum, M.D., associate professor, surgery and surgical outcomes and gastrointestinal surgeon, University of Washington, Seattle; E. Patchen Dellinger, M.D., professor and vice chairman, department of surgery, and chief, division of general surgery, University of Washington, Seattle; Aug. 22/29, 2007, Journal of the American Medical Association