LAPAROSCOPIC MANAGEMENT OF ACUTE PERITONITIS

Background The presence of peritonitis has previously been considered to be a contraindication for the laparoscopic approach because of the theoretical risk of malignant hypercapnia and toxic shock syndrome, Th e aim of this retrospective study was to demonstrate that laparoscopy is feasible, safe and effieient in cases of peritonitis. Methods From January 1990 to July 1995, 231 patients had a laparoscopy for acute pe ritonitis in two centres (91 appendicular peritonitis, 69 gastroduoden al perforated ulcers, 35 perforations of the colon, 36 miscellaneous). Results The diagnostic accuracy of laparoscopic exploration was 548 p er cent. The clinical preoperative diagnosis was changed by laparoscop ic exploration in 25.1 per cent of patients, An unnecessary laparotomy was avoided in 6.5 per cent of patients and the site of traditional i ncision was modified in 8.7 per cent, Conversion rates were 25 per cen t for appendicular peritonitis, 16 per cent for gastroduodenal perfora tion and 83 per cent (29 of 35 patients) for colonic perforation. The overall mortality rate was 3.9 per cent, No malignant hypercapnia occu rred. Two patients (0.9 per cent) had postoperative septic shock but s urvived. Conclusion Laparoscopy is feasible and safe in cases of perit onitis. Laparoscopic treatment is particularly effective in the case o f appendicular and gastroduodenal perforation, Irt the case of colonic perforation, the conversion rate remains high bur with growing experi ence and surgical skill, more of these casts will be treated laparosco pically in the future.