Untitled

Abstract

The use of laparoscopy in generalized peritonitis has become increasingly frequent in recent years. However, CO2 pneumoperitoneum in association with increased intraperitoneal pressure may have deleterious effects in patients with hemodynamic or metabolic disturbances caused by bacterial peritonitis. The purpose of this study was to investigate the effect of CO2 pneumoperitoneum on bacteremia, mean arterial pressure, and blood gas disturbances in an animal model of bacterial peritonitis. Dogs were anesthetized, orally intubated, and subjected to experimental peritonitis by intraperitoneal inoculation of a suspension containing Escherichia coli and sterile dog feces. The animals were randomly assigned to two groups: control animals were maintained under anesthesia, and the insufflated animals were subjected to intraperitoneal CO2 insufflation. Bacterial peritonitis provoked the appearance of bacteremia and a significant decrease in mean arterial pressure, pH, bicarbonate, and base deficit. The induction of bacterial peritonitis did not significantly influence pH in the control group and partial pressure of arterial CO2 in either group. Thirty minutes of CO2 pneumoperitoneum did not influence the effect of bacterial peritonitis on the analyzed variables. These results suggest that laparoscopic CO2 pneumoperitoneum does not aggravate bacteremia or metabolic and hemodynamic disturbances induced by bacterial peritonitis.

Emergency laparoscopic ileo-colic resection and primary intracorporeal anastomosis for Crohn’s acute ileitis with free perforation and faecal peritonitis: first ever reported laparoscopic treatment

“…Although peritonitis used to be commonly considered a contraindication to laparoscopy, because of the theoretical concern that the CO2 pneumoperitoneum that may enhance bacteraemia and endotoxemia due to the increased intraperitoneal pressure (Nordentoft et al 2000 ), the latest guidelines by EAES and most of the clinical and experimental studies support the concept that laparoscopy and minimally invasive surgery are able to produce a less inflammatory response with a less risk of kidney and lung failure, less trauma and tissue damage than open surgery (Uzunkoy et al 2012 ; Pitombo 2008 ; Montalto et al 2012 ; Metzelder et al 2008 ; Hsieh et al 2011 ; Horattas et al 2003 ; Hanly et al 2003 ; Casaroli et al 2011 ; Barbaros et al 2004 ; Kesici et al 2011 ; Collet e Silva et al 2000 ; Neudecker et al 2002 ). In fact, over the past few years there has been an increasing number of studies on the use of laparoscopy in the treatment of peritonitis reporting favourable results (Sauerland et al 2006 ; Branicki 2002 ; Di Saverio 2014 ; Cueto 1997 ; Agresta et al 2006 ; Kirshtein 2003 ; Agresta et al 2004 ; Sangrasi et al 2013 ; Agresta et al 2012 ).…”

“…The technique for intestinal anastomoses in CD is still controversial, and, to date, there is no evidence of outcome difference between hand-sewn and stapled anastomosis (Scarpa et al 2003 ). A temporary end-ileostomy or a diverting loop-ileostomy proximal to the anastomosis, can be considered in CD, especially in case of peritonitis with hemodynamic instability and when the patient’s general conditions and nutritional status are extremely poor (Ikeuchi and Yamamura 2002 ; Nordentoft et al 2000 ; Kesici et al 2011 ; Collet e Silva et al 2000 ; Neudecker et al 2002 ; Agresta et al 2012 ; O’Sullivan et al 1996 Apr; Favuzza et al 2009 ; Karoui et al 2009 ; Myers et al 2008 ; Thomson and Tam 1994 ; Croft et al 1995 ; Smyth et al 1994 ; FitzSimmons et al 1997 ; Greenstein et al 1985 , 1987 ; Abascal et al 1982 ; Parray et al 2011 ).…”