[Laparoscopic treatment of appendiceal peritonitis in adults]

The aim of this study was to evaluate the results of laparoscopic treatment of appendicular peritonitis.

From January 1991 to December 1994, 32 patients (16 men and 16 women with a mean age of 43 years) underwent emergency laparoscopy for a clinical diagnosis of localized or generalized appendicular peritonitis. All patients had double antibiotic therapy for at least 7 days. The laparoscopic appendectomy technique consisted of:insufflation to 12 mmHg, introduction of 3 trocars, first peritoneal lavage, coagulation of the mesoappendix, ligature of the base of the appendix, no drainage.

There were 4 conversions (12.5%). Nine of the 28 cases treated completely by laparoscopy, presented generalized peritonitis and 19 presented localized peritonitis (including 8 abscesses). The operations were performed by 7 surgeons and the mean operating time was 86 minutes. There were no deaths. The postoperative morbidity was 10.7%. The mean duration of postoperative ileus was 2.8 days. The mean hospital stay was 6.8 days. Histological examination concluded on acute suppurative appendicitis 96.4% of cases. There were no bowel obstructions or incisional hernias with a mean followup of 28.5 months.

The laparoscopic treatment of appendicular peritonitis is possible, simple and reproducible, effective, without any specific complications. The advantages of laparoscopic techniques over the traditional large incisions are the absence of parietal complications, the quality of exploration and peritoneal lavage, and improvement of postoperative comfort.