Modern opportunities in laparoscopic treatment of acute peritonitis of variety origin
DOI:
https://doi.org/10.5281/zenodo.14860181Keywords:
laparoscopy, peritonitis, appendicitis, cholecystitis, diverticulitis, perforated ulcerAbstract
Objective: Laparoscopy is a preferred surgical approach in various disease conditions, because of the high diagnostic value and the possibility of minimal traumatic treatment. These advantages of the laparoscopic surgery are undeniable.
Purpose: To analyze the experience and results in the treatment of acute peritonitis in the Clinic of Surgery of the University Hospital "St. Anna" Sofia, through a laparoscopic approach and to compare them with data from the literature. Materials and methods: We did a retrospective, non-randomized analysis of the patients operated in the clinic on the occasion of peritonitis for a four-year period (2019 – 2022). Of the total amount of 420 patients, 128 underwent laparoscopy, with 86 (67%) operated minimally invasively, and in 42 (33%) cases was performed a conversion. We analyzed the accuracy of diagnosis, conversion rate, operative time, morbidity and lethality.
Results: The diagnostic value of laparoscopic exploration was 93%. Peritonitis of appendicular origin was found in 52 patients – 40 of whom were treated with laparoscopic appendectomy. In 12 of the cases (23%) conversion was required. Perforated gastro-duodenal ulcer was diagnosed in 38 patients, 16 of whom were sutured laparoscopically, and in the remaining 22 cases was required a conversion. In 25 patients, laparoscopic cholecystectomy was performed, lavage and drainage on the occasion of biliary peritonitis. The remaining 13 patients with laparoscopic approach were with acute diverticulitis, pelvioperitonitis or peritonitis with other genesis.
Conclusion: The laparoscopic approach in patients with acute peritonitis who are not in a shock state is safe and reliable. Laparoscopic operation is effective for diagnostic clarification and verification of the diagnosis, as well as for planning a subsequent surgical method, which can reduce the volume of surgical trauma and the size of the laparotomy. Laparoscopic treatment of acute peritonitis brings undeniable positives for the patient - reduced postoperative pain, better post-operative comfort, faster recovery, fewer wound complications, shorter hospital stays and better cosmetic results.
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