The efficacy of laparoscopic surgery in patients with peritonitis

Laparoscopy is an essential part of our armamentarium in certain conditions and has been recently begun to be used on acute abdominal peritonitis effectively and frequently by surgeons. But, there is still a debate on laparoscopic management of surgical emergencies. The aim of the current study is to evaluate the safety and efficiency of laparoscopy and its role in patients with acute abdominal emergencies retrospectively.

From May 2002 to May 2006, 147 patients with provisional diagnosis of acute abdomen were operated laparoscopically (68 suspected lower quadrant peritonitis, 17 gastroduodenal perforated ulcers, and 62 cholecystitis).

A definitive diagnosis was accomplished in 93.1% (137 patients) of the cases and 85.7% (126) of the patients were successfully treated by emergent laparoscopy. An unnecessary laparotomy was avoided in 17.0% (24 women and 1 man) of the patients. The conversion rate was 14.2%. The morbidity rate was 4.0% with a postoperative mortality rate of 0.68%. After a mean period of 16.2 months, postoperative evolutions of patients were satisfactory.

Laparoscopic surgery, with high diagnostic accuracy and therapeutic capabilities, can be safely and effectively applied to the patients with acute abdominal emergencies in experienced hands. We believe that laparoscopy is a valuable way to prevent unnecessary laparotomies when routine investigations fail to identify the cause. This technique can be widely used in abdominal emergencies with increasing experience, but further studies are required to definitively establish its role in acute abdominal disorders.