Laparoscopic treatment of non traumatic peritonitis of digestive or extra-digestive origin: A ten-year study

PURPOSE: Localized or generalized peritonitis is one of the most serious complications of many abdominal or pelvic diseases. Laparoscopy has been used cautiously, because of technical difficulties and the theoretical risks of poorly controlled sepsis, overlooked lesions, and suboptimal treatment due to poor vision.
METHODS: Data were retrospectively collected from May 1998 to April 2007 in a single referral center specialized in abdominal emergencies either digestive or non-digestive. All patients with non-peritonitis infectious or non infectious (e.i., hemorrhagic, inflammatory, obstructive) diagnosis were excluded from the study
RESULTS: Three hundred and twelve patients were included in the study. The median Mannheim Peritonitis Index score was 27 (+/-5; range, 12-38). The conversion rate was 18.6 %. There was no perioperative uncontrolled sepsis. Overall operative 30-day mortality and morbidity rates were 2.5 % and 25.3 %, respectively. The 2 most common diagnosis was acute appendicitis (122 cases), followed by pelvic inflammatory disease (64 cases). Other diagnosis included acute diverticulitis, post-operative, acute cholecystitis, perforated ulcer, perforated Meckel’s diverticulum, iatrogenic post-endoscopic, and miscellaneous causes. A comparison of the patients with successful laparoscopic treatment (N=254) and those who had conversion (N=58) or open procedures (N = 401) during the same period was performed.
CONCLUSIONS: The indications of laparoscopy in abdominal emergencies could be safely extrapolated to selected patients with peritonitis. The technical feasibility and safety of theses procedures seem solid. The risk of conversion is high. However, sepsis control is very efficacious and post-operative complications seem to be lowered as compared to patients who had open or converted procedures.

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Program Number: P370

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