LAPAROSCOPIC VS OPEN REPAIR OF GASTRIC PERFORATION AND ABDOMINAL LAVAGE OF ASSOCIATED PERITONITIS IN PIGS

Background: Laparoscopy is increasingly used in conditions complicated by peritonitis, e.g., peptic ulcer perforation. Of some theoretical c oncern is the capnoperitoneum, which may aggravate intraabdominal pres sure and distension of the peritoneum. This animal study was devised t o analyze the effectiveness of laparoscopic versus traditional open re pair of gastric perforation and abdominal lavage for associated perito nitis. Methods: To simulate gastric perforation, female Duroc pigs wer e subjects to standardized gastrotomy. Either 6 or 12 h after gastric perforation, the animals underwent either traditional open or laparosc opic repair of the gastric defect and peritoneal lavage. The subjects were divided into the following four groups: peritonitis for 6 h and o pen surgery (group I) or laparoscopic surgery (group II); peritonitis for 12 h and open surgery (group III) or laparoscopic surgery (group I V). After an observation period of 6 days, the surviving animals were killed. The main outcome criteria were survival, perioperative changes of hemodynamics suggestive for septic shock, bacteremia, and endotoxe mia. Results: There were no significant differences between group I an d II. Mortality was 22% in group III, as compared to 78% in group IV ( p = 0.045). In group IV, the incidence of perioperative bacteremia and plasma endotoxin concentrations were significantly, higher than in gr oup III. Concomitantly, decreased mean arterial pressure and systemic vascular resistance, and increased cardiac output suggested a higher i ncidence of septic shock in group IV. Conclusion: Critical appraisal o f laparoscopic surgery is warranted in conditions associated with seve re, longstanding peritonitis.