Role of laparoscopy in peritonitis (original) (raw)
Related papers
Peritonitis: laparoscopic approach
2006
Background: Laparoscopy has became as the preferred surgical approach to a number of different diseases because it allows a correct diagnosis and treatment at the same time. In abdominal emergencies, both components of treatment -exploration to identify the causative pathology and performance of an appropriate operation -can often be accomplished via laparoscopy. There is still a debate of peritonitis as a contraindication to this kind of approach. Aim of the present work is to illustrate retrospectively the results of a case-control experience of laparoscopic vs. open surgery for abdominal peritonitis emergencies carried out at our institution.
Assessment of Laparoscopic Management of Intestinal Perforation
2021
Background: Intestinal perforation is a surgical emergency often, encountered. Usually, coelotomy is performed to manage intestinal perforation. It has been the gold standard approach to deal with intestinal perforation for the past decades in conjunction with various procedures. Post laparotomy wound related complications have been the biggest challenge for general surgeons till date, so much as to adding up to morbidity, as severe as burst abdomen. Laparoscopic management of perforation is a recent technique. Aim: The present study is aimed to assess the efficacy of laparoscopic management of intestinal perforation. Material and Method: Prospective study of 75 patient admitted and operated in National Institute of Medical Sciences & Research. Intestinal perforation (traumatic and not traumatic) will be managed through laparoscopic procedure. The perforated intestine will be – Identified and exteriorized with or without repair of perforation. Adequate peritoneal toilet would be per...
Outcome of Laparotomy for Peritonitis in 302 Consecutive Patients in Ibadan, Nigeria
Annals of Ibadan Postgraduate Medicine, 2016
Background: Peritonitis is a life-threatening condition and requires urgent surgical management. Despite improvements in the care of patients with peritonitis, its management is still challenging and associated with significant morbidity and mortality. The aim of this study was to determine factors influencing the outcome in patients managed for peritonitis in a tertiary health institution in Nigeria. Method: A retrospective study involving 302 patients managed for peritonitis over a 3- year period. The biodata, clinical findings, diagnosis, pre-operative care, mode of anaesthesia, cadre of the surgeon, intraoperative findings, postoperative care, and the outcomes were retrieved from their records. Results: Three hundred and two patients were operated on for peritonitis during the period. The mean age of the patients was 48 ± 12 years. Twenty (6.6%) patients had other co-morbidities, with hypertension being the most frequent. Ruptured appendicitis was the most common cause of perito...
The efficacy of laparoscopic surgery in the diagnosis and treatment of peritonitis
Surgical Endoscop, 1997
Background: Peritonitis continues to be an important cause of morbidity and mortality and often an etiologic diagnosis is unclear. To evaluate the efficacy and safety of laparoscopy the authors analyzed their 5-year experience with this modality of treatment. Methods: A review was made of 107 consecutive nonselected laparoscopic procedures performed between October 1990 and November 1995. The diagnosis was established by clinical, laboratory, and imaging findings and confirmed by laparoscopy and/or laparotomy. Results: An etiologic diagnosis was unclear in 35% of the cases and was established in all by laparoscopy; 94 patients (87.9%) were successfully treated by laparoscopy while 13 (12.1%) required conversion. Mortality was 4.6%; 14% had postoperative complications and 7.4% had reoperations. Conclusions: Laparoscopic surgery is safe and very efficient in the diagnosis and treatment of patients with peritonitis. In most instances a definitive treatment can be carried out without conversion and has the additional and wellknown advantages of minimally invasive surgery.
Comparison of Laparoscopic Versus Open Repair for Gastro Intestinal Perforation
Background Gastrointestinal perforation a common abdominal emergency treated by the general surgeon. It is a common dictum that abdomen is a Pandora's Box and gastrointestinal perforation is one such condition to prove it. There is great controversy regarding the choice of procedure for gastro intestinal perforation of patients. The purpose of this study was to compare the early outcome results of laparoscopic and open repair and to propose which risk factors influence the outcome. Methods Between January 2018 and august 2019, 20 patients underwent laparoscopic and 30 patients underwent open repair of gastro intestinal perforation in a m.p shah medical college. The results were retrospectively analyzed. The primary outcome measures included operative time, duration of hospital stay, morbidity, and mortality. Results The most common site for gastro intestinal perforation is duodenum accounting for 60% of cases then followed by appendicular, ileal, gastric, jejuna, meckels diverticulum and colon in order of occurrence.There is clear male preponderance with males accounting for 72% of cases.Maximum cases are found in age group of 41-60 years accounting for 44% of cases.In 45% of cases size of perforation was 1-2 cm; it was less than 1 cm in 30% of cases and rest 25% only had perforation of greater than 2 cm size.Pain was the most constant clinical symptom, present in all 50 cases followed by vomiting and abdominal distension.Open laparotomy is the treatment of choice in our institute, done in 60% of cases rest 40% were tried laparoscopically but of these, 2 cases had to be converted to open laparotomy.Intra operative complications are having very low rates.The average postoperative stay of patients in hospital is 4 days for laparoscopic approach and 8 days for open laparotomy.Post operative complications were almost negligible in laproscopic approach and it was only 10% in open laparotomy approach. Hence it is seen that complication rates are low in our institute. Conclusions In our study , duodenal perforations were common. Most of them were male patients with smoking and alcohol consumption and in the fourth decade of their life. In a small percentage of patients perforations are the first clinical manifestation of an acid-peptic disease. Repair with omental patch followed by treatment for acid-peptic disease with drugs was done in each case with success. Appendicular perforations were the second most common perforations in our study. Ileal perforations were mostly due to typhoid ulcer perforations. Inspite of recent advances in closing perforation by laparoscopy and by other means, still simple closure with omental patch was widely practiced in the study group. The interval between the symptoms and the intervention along with initial resuscitation are important prognostic factors for a good outcome. The most common post-operative complication was wound infection.
PERFORATIVE PERITONITIS: CONTINUING SURGICAL CHALLENGE.(PROSPECTIVE STUDY OF 50 CASES)
International Journal of Medical Reviews and Case Reports, 2022
Background: Perforative peritonitis poses a significant diagnostic and therapeutic challenge to the attending surgeon. Delay in diagnosis followed by sub-optimal treatment may lead to many complications, thereby increasing both morbidity and mortality. This is by virtue of various factors which affect the prognosis. Hence the need arises to identify these prognostic factors. Aims and Objectives: To study the various etiological factors of perforative peritonitis and to identify prognostic factors and comorbid conditions which influence the outcome in perforative peritonitis. Materials and Methods: 50 patients with an established diagnosis of perforative peritonitis due to various aetiologies confirmed by clinical and radiological investigations were included in the study and studied prospectively. On admission to the hospital, various haematological and radiological investigations were conducted to confirm the diagnosis. Patients subsequently underwent surgical intervention. Postoperative recovery and outcomes assessed. Results were tabulated and statistically analysed. Results: The mean age of patients in the study was 36.5 ±5 years. Patients who presented in an advanced stage developed complications. The majority of patients were males. The interval between the onset of symptoms and operative intervention was directly related to postoperative complications. Pneumoperitoneum was the most common x-ray finding, followed by dilated bowel loops with free fluid in the peritoneal cavity as the most common ultrasonography finding. Tachycardia and oliguria, which were markers of the severity of the disease process, were associated with an increased rate of complications. Peptic ulcer perforation was the most common, followed by perforations caused by infective aetiology. Perforations caused by infective aetiology had a higher rate of complication. Primary closure of the perforation was the most commonly performed procedure. Significant abdominal contamination found intraoperatively contributed to a negative outcome, as were comorbid conditions, which also increased the complication rate significantly. Conclusion: Delayed intervention after the onset of symptoms, tachycardia, oliguria and comorbidities are associated with a higher complication rate. Radiological investigations help in confirming the diagnosis. Infective aetiology of the perforation and extensive peritoneal contamination was associated with higher complication rates. Prompt and aggressive resuscitation on admission, optimum antibiotic administration, and early meticulous surgical intervention can reduce morbidity and mortality to a bare minimum.
Laparoscopic management of perforated appendicitis-a study of 90 cases
2020
Introduction: Acute appendicitis is the most common general surgical emergency in the world. It may cause potential risk for patients due to its life threaten complications like burst (perforation). The perforated appendicitis often leads to serious infectious complication like abdominal sepsis, pelvic abscess & etc. There are concerns of using laparoscopic appendectomy to perforated appendicitis. Now a days laparoscopic management of perforated appendicitis is the standard surgical option in many countries. Laparoscopic procedure has tremendous advantages over the open procedure regarding its diagnosis, exclusion of additional pathology, surgical treatment, wound infection (port infection), hospital stay & overall patients satisfaction. The aim of this prospective study was to evaluate the role and application of laparoscopy in the management of complicated appendicitis (perforation). Methods: It is a prospective study conducting during January 2011 to May 2019 in BSMMU and some pr...
Laparoscopic repair of small bowel perforation
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
For years, limiting operative wound sepsis and its resultant morbidity in patients with small bowel perforations has been a major headache for surgeons. The present study was intended to extend the benefits of minimally invasive surgery to traumatic and typhoid small bowel perforations, in terms of assessing its feasibility and limiting wound sepsis. Twenty-five patients (20 with typhoid ileal and 5 with traumatic small bowel perforation) presenting within 96 hours of the catastrophe were included in the study. All were explored laparoscopically, and the perforation repaired by intracorporeal suturing. Time of operation varied from 45 minutes to 92 minutes. Two patients developed port-site infection. None of the patients developed postoperative fistula, and no mortalities occurred. Postoperative hospital stay was between 7 days and 10 days. Benefits of minimally invasive surgery can be safely and efficaciously extended to select patients with small bowel perforation in terms of limi...
Gastroenterology Review, 2013
Introduction: Duodenal perforation is one of the common pathologies in patients presenting in emergency with acute abdominal pain in an emergency ward and requires prompt surgery as life saving and curative intervention. The present study was conducted to determine whether the minimal access approach by laparoscopy was equally feasible as the open method. Aim: To compare laparoscopic vs. open management duodenal perforation in all aspects. Material and methods: Inclusion criteria: patients presenting to the emergency ward with acute pain in the abdomen with clinical signs of peritonitis and air under the diaphragm on X-ray abdomen standing were selected. Exclusion criteria were: patient age < 15 years and > 70 years, presentation > 2 days, shock with systolic blood pressure < 90 mm Hg which did not improve after hydration with 2000 ml of Ringer lactate solution, respiratory distress, history of cardiac disorder or respiratory disorders such as ischemic heart disease, arrhythmias, chronic obstructive pulmonary disease or asthma, bleeding and clotting disorders, pregnancy in females, previous upper abdominal surgery, and intra-operatively patients having perforation other than duodenal perforation. After excluding patients fitting the above criteria, two groups-test and control-were formed. Results: We found that complications both early and late were significantly fewer in patients treated by laparoscopy. Thus laparoscopy was both feasible and had comparable mortality and leakage rate. Conclusions: Laparoscopic management of perforated duodenal ulcer is feasible, effective and decreases morbidity and overall treatment time and cost if performed in properly selected patients.
Laparoscopic management of colonoscopic perforations
Surgical endoscopy, 2000
Colonic perforation is a dangerous complication of colonoscopy, both diagnostic and therapeutic, and its management has become controversial. The question of conservative vs operative treatment is still under debate. Despite the recent expansion and wide acceptance of laparoscopy by surgeons, the feasibility of this technique as a means of treating abdominal emergencies has also been questioned. Of 575 patients admitted to our institution for abdominal emergencies between 1993 and 1998, 365 were treated via a laparoscopic approach. Two of these patients were treated for colonoscopic perforations, one after a diagnostic procedure and one after an operative procedure. Our technique employs an open umbilical approach with two other trocars introduced in the right iliac fossa and left flank. In the first case, a diverticular perforation of the subperitoneal rectum was suspected. The abdomen was copiously irrigated with saline solution and a drain was left in the pelvis. In the second pa...