Laparoscopic surgery for advanced peritonitis

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Lebedev N.V.

People’s Friendship University of Russia

ORCID: 0000-0002-7745-1390

Klimov A.E.

People’s Friendship University of Russia

ORCID: 0000-0002-0001-8003

Popov V.S.

People’s Friendship University of Russia

ORCID: 0000-0001-7415-6794

Abuladze I.O.

People’s Friendship University of Russia

ORCID: 0000-0002-3576-4815

Barkhudarov A.A.

People’s Friendship University of Russia

ORCID: 0000-0002-7494-013X

Laparoscopic surgery for advanced peritonitis

Authors:

Lebedev N.V., Klimov A.E., Popov V.S., Abuladze I.O., Barkhudarov A.A.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2024;(10): 21‑28

DOI: 10.17116/hirurgia202410121

Views: 800

Downloaded: 24

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To cite this article:

Lebedev NV, Klimov AE, Popov VS, Abuladze IO, Barkhudarov AA. Laparoscopic surgery for advanced peritonitis. Pirogov Russian Journal of Surgery. 2024;(10):21‑28. (In Russ.)
https://doi.org/10.17116/hirurgia202410121

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OBJECTIVE

To determine the criteria for choosing surgical access in patients with advanced peritonitis considering its local and general manifestations.

MATERIAL AND METHODS

We analyzed treatment outcomes in 588 patients with advanced peritonitis. The most common causes of peritonitis were destructive forms of acute appendicitis (273 cases), perforated gastroduodenal ulcers (165 cases), acute cholecystitis (59 cases). To determine the criteria for choosing surgical access in advanced peritonitis, we analyzed treatment outcomes considering MPI, SPP and WSES SSS score.

RESULTS

The choice of surgical access in advanced peritonitis can only symbolically be standardized according to modern scoring systems (MPI, SPP, WSES SSS). Laparotomy is necessary for MPI score ≥30 and SPP score > 10 (WSES SSS score > 8). Regardless of MPI, SPP, WSES SSS scores, the absolute contraindications for laparoscopic surgery are dense non-removable fibrin deposits, interintestinal abscesses, purulent recesses, intra-abdominal pressure > 20 mm Hg or small intestine dilation> 3 cm, sepsis or septic shock (qSOFA score 2—3), previous open abdominal surgery, unstable hemodynamics, technical difficulties. Conversion should be used at any doubt.

CONCLUSION

Careful patient selection, surgical experience and training in laparoscopic technique are decisive factors for wider use of laparoscopic approach in patients undergoing emergency abdominal surgery.

Keywords:

laparoscopic surgery

laparotomy

secondary advanced peritonitis

Authors:

Lebedev N.V.

People’s Friendship University of Russia

ORCID: 0000-0002-7745-1390

Klimov A.E.

People’s Friendship University of Russia

ORCID: 0000-0002-0001-8003

Popov V.S.

People’s Friendship University of Russia

ORCID: 0000-0001-7415-6794

Abuladze I.O.

People’s Friendship University of Russia

ORCID: 0000-0002-3576-4815

Barkhudarov A.A.

People’s Friendship University of Russia

ORCID: 0000-0002-7494-013X

Received:

23.01.2024

Accepted:

21.03.2024

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