Discussion Surgical treatment is inseparable part of patient care with severe peritonitis. Advance monitoring is important for identification of risk patients but also for possible surgical revision indication. Generally used sepsis markers including scoring systems (APACHE II, MOSF - Multiple Organ System Failure, MODS - Multiple Organ Dysfunction Score) however react with certain delay. Possible or on demand re-laparotomy is performed afterwards in patient in severe conditions with MODS. On the other hand planned re-laparotomies are conducted excessively. Not even met-analysis of clinical studies proved clear preference of one procedure (23). New method VAC however has not been evaluated in prospective randomized study in this indication. Inclusion of early markers of septic state - IL-1, 6, 8, 10 a TNF alpha - in indication for re-laparotomy or VAC exchange could have large clinical benefit. Further controversial indication parameter commonly measured at ICU is size and development of IAP which can present important correlation with laboratory signs of inflammation and it can lead for design of special index. VAC method use has its advantages - active and closed intraabdominal secretion restricts possibilities of spreading HAI. Significant and reduced frequency of dressing; enables simple physiotherapy of patients; condition of anabolic phase which is necessary for any healing (24). Analysis of patient number which benefit from this method (intention-to treat) against general costs is necessary.