Role of laparoscopy in peritonitis

Abstract

Objective: Laparoscopy has gained clinical acceptance in many subspecialties in the last decade. The conventional open surgery for peritonitis carries significant morbidity and mortality. The present study was done to extend and evaluate benefits of minimally invasive surgery in this subset of patients. Methods: This was a prospective study spanning over a period of four years. All those patients diagnosed as having peritonitis on clinical assessment and preoperative investigations and those who were stable enough haemodynamically were included in this study. After initial resuscitation for few hours, they underwent diagnostic and therapeutic laparoscopy to identify the cause of peritonitis and to confirm the pathology. All cases were done under general anesthesia, using three standard ports at appropriate sites according to pathology. Patients were treated by different procedures either laparoscopically or with laparoscopic assistance after diagnosis. Operative and post operative data was collected and analyzed. Results: Ninety two cases of peritonitis underwent diagnostic and therapeutic laparoscopy. Mean age of patient was 46.5 years. 24 patients were diagnosed as perforated duodenal, in 14 (58.3%) patients laparoscopic suture repair was done and in 8 (33.3%) small upper midline incision was given and perforation was repaired. Out of 32 patients having perforated appendix, 25 (78.1%) patients laparoscopic appendectomy was done while in 7 (21.8%) perforation was dealt by laparoscopic assistance. Out of 14 patients of ileal perforation 6 (42.8%) with minimal contamination laparoscopic suture was applied, while in 8 (57.1%), perforated loop was brought out by making small window and perforation was closed. All 22 patients with pelvic sepsis needed only aspiration of pus and peritoneal lavage. Only one patient died post operatively and 2 (2.1%) patients developed fistula. 6 (6.5%) patients developed port site infection. Conclusion: Laparoscopic management is feasible, safe and effective surgical option for patients with peritonitis due to different abdominal emergencies in properly selected cases with higher diagnostic yield and a faster postoperative recovery.

Role of Laparoscopy in Perforation Peritonitis

“…Out of 33 cases of appendicular perforation, 5 patients (15.2%) with appendicular perforation required conversion to open surgery, which was consistent with 16% conversion rate in study by Sleem R et al [18] and slightly lower compared to 22% as per study conducted by Ahmed Khan Sangrasi. [9] Similar conversion rate of 22.8% was found in study conducted by Ferdinando Agresta et al [19] Our conversion rates were lower than other due to high expertise in this surgery for uncomplicated appendicitis. All of the cases in which we needed conversion was due to dense adhesions.…”

“…Mean age of patients in our study was 41.62 years, which was slightly lower than the mean age of 46.5 years as per study conducted by Ahmed Khan Sangrasi. [9] In our study, 71.3% cases constitute the males and 28.7% females. Appendicular perforation was most common cause of peritonitis in our study which is in consistent with study conducted by Dr. H. L. Leuva.…”

“…All of the cases in which we needed conversion was due to dense adhesions. Morbidity and mortality in our study was 18.1% and zero % as compared to 6.2% and zero respectively in study conducted by Ahmed Khan Sangrasi et al, [9] versus 9% and 1% respectively by Navez B et al [14] Gastroduodenal Perforation Mean age of patients presenting with gastro-duodenal perforation in our study was 54.14 ± 14.4 yrs. which was slightly lower than the study conducted by Ferdinando Agresta et al [20] and was consistent with age of 59 years as in study conducted by Simone Guadagni et al [21] Laparoscopic repair was successful in 4 patients (57.1%) while in 3 patients (42.9%), laparoscopy was converted to midline laparotomy.…”

“…[13] We obtained correct diagnosis in all the cases in our study group. Our diagnostic yield is better than as reported by Navez et al [14] Only 88% correct diagnosis were made by study conducted by Ahmed Khan Sangrasi et al [9] 72.3% of patients were diagnosed preoperatively on the basis of radiological investigations as compared to study by Lagoo S et al [12] in which 80-90% were diagnosed to be a case of perforation peritonitis on the basis of radiological investigations.…”

“…[10] Gall bladder perforation was 2 nd most common perforation in our study group followed by small bowel perforation. Out of 94 cases, 13.8% were diagnosed as a case of ileal perforation compared to 15.2% cases diagnosed to be ileal perforations in a similar study by Ahmed Khan Sangrasi et al [9] Diagnostic accuracy of laparoscopic exploration is reported to be around 90 percent in study conducted by Navez et al [11,12] also as high as 98% as reported by Kirshtein. [13] We obtained correct diagnosis in all the cases in our study group.…”