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Peritonitis: laparoscopic approach.

Ferdinando Agresta1, Luigi Francesco Ciardo, Giorgio Mazzarolo

  • 1Department of General Surgery, Presidio Ospedaliero di Vittorio Veneto, Vittorio Veneto, (TV) Italy. fagresta@libero.it.

World Journal of Emergency Surgery : WJES
|June 9, 2006
PubMed
Summary
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Laparoscopic surgery for abdominal peritonitis emergencies is safe and effective, offering higher diagnostic accuracy and faster recovery than open surgery. This approach provides a viable alternative for managing peritonitis.

Area of Science:

  • Minimally Invasive Surgery
  • Emergency Medicine
  • Surgical Gastroenterology

Background:

  • Laparoscopy is increasingly preferred for diagnosis and treatment.
  • Its use in abdominal emergencies, including peritonitis, is debated.
  • This study evaluates laparoscopic vs. open surgery for peritonitis emergencies.

Purpose of the Study:

  • To retrospectively compare laparoscopic and open surgery outcomes for abdominal peritonitis.
  • To assess the safety and efficacy of laparoscopy in peritonitis management.
  • To determine if peritonitis is a contraindication for laparoscopic surgery.

Main Methods:

  • A case-control study of 935 patients undergoing emergent/urgent surgery (1992-2002).
  • 602 patients (64.3%) had laparoscopic surgery, including 112 with peritonitis.

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  • Exclusion criteria: malignancy, >2 prior abdominal surgeries, massive bowel distension. Peritonitis was not an exclusion criterion.

    • Main Results:

    • Conversion rate to open surgery was 23.2% in peritonitis patients, mainly due to adhesions.
    • Major complications occurred in 5.3%, with a 1.7% postoperative mortality.
    • Laparoscopy achieved a definitive diagnosis in 85.7% and successful treatment in 90.6% of these cases.

    Conclusions:

    • Laparoscopic approach to abdominal peritonitis is safe and effective compared to open surgery.
    • It offers higher diagnostic yield, less trauma, and faster recovery.
    • Laparoscopy presents a challenging alternative in the management of abdominal peritonitis emergencies.