Principles and benefits of the laparoscopic approach in appendicular peritonitis

Abstract

Purpose and objectives. Peritoneal complications of acute appendicitis are inevitable and require a firm attitude both in terms of reducing intraoperative risks but especially in choosing the appropriate therapeutic approach. Material and method. The paper presents a retrospective biostatistical study of appendicular peritonites operated laparoscopically in the General Surgery Clinic of “Sf. Ioan” Emergency Clinical Hospital of Bucharest between January 2008 and December 2016. Results. There were 1,275 cases with various forms of acute appendicitis, of which 278 (21.80%) were complicated forms. Among them, 94 cases (7.37%) presented generalized peritonitis with different degrees of severity and 184 (14.43%) cases were localized peritonitis. Generalized peritonitis of appendicular cause was operated laparoscopically in almost 71.27% of the cases (67 out of 94 generalized peritonitis of appendicular cause). The incidence of postoperative complications was significantly lower in the case of the laparoscopic approach of appendicular peritonitis (p < 0.0001), compared to conventional operations. Conclusions. The indications and limits of the laparoscopic approach in the treatment of appendicular peritonitis are largely dictated by the severity of the lesions, but the experience of the operating team also has an important role.

Keywords

• minimally invasive approach
• appendectomy
• complications
• lavage
• peritoneal drainage
• conventional surgery