Emergency laparoscopic surgery for right colonic diseases with peritonitis

Laparoscopic bowel resection for right colonic diseases with peritonitis is technically difficult and time-consuming, particularly in the presence of hard adhesion and dense inflammation. Moreover, peritonitis frequently leads to an emergency operation. Therefore, we evaluated the feasibility and effectiveness of emergency laparoscopic bowel resection in patients with these diseases.

During 3 years (November 2006 to October 2009), we enrolled 31 consecutive patients who underwent an emergency laparoscopic bowel resection for right colonic disease with peritonitis. In 2 patients, perforated malignancy was suspected preoperatively, but there was no patient with malignancy at pathologic finding. We analyzed the clinical outcomes, including complications.

The mean operating time was 140 minutes, and the mean hospital stay was 10 days. There was 1 conversion (3%), and the other intraoperative procedures were uneventful. Four complications (13%) occurred after treatment (1 intra-abdominal abscess, 2 wound abscesses, and 1 adhesive ileus). The intra-abdominal abscess was treated by subsequent percutaneous drainage; the wound abscesses were treated conservatively. One patient with an adhesive ileus 12 months after treatment was managed with a bowel resection. After a median follow-up of 16 months, the other patients had no complications.

Emergency laparoscopic bowel resection may be a feasible, effective method for the treatment of right colonic diseases with peritonitis.