title: Peritonitis: laparoscopic approach.
abstract: 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.
  
  
  METHODS
  From January 1992 and January 2002 a total of 935 patients (mean age 42.3 +/- 17.2 years) underwent emergent and/or urgent surgery. Among them, 602 (64.3%) were operated on laparoscopically (of whom 112 -18.7% - with peritonitis), according to the presence of a surgical team trained in laparoscopy. Patients with a history of malignancy, more than two previous major abdominal surgeries or massive bowel distension were not treated Laparoscopically. Peritonitis was not considered contraindication to Laparoscopy.
  
  
  RESULTS
  The conversion rate was 23.2% in patients with peritonitis and was mainly due to the presence of dense intra-abdominal adhesions. Major complications ranged as high as 5.3% with a postoperative mortality of 1.7%. A definitive diagnosis was accomplished in 85.7% (96 pat.) of cases, and 90.6% (87) of these patients were treated successfully by Laparoscopy.
  
  
  CONCLUSIONS
  Even if limited by its retrospective feature, the present experience let us to consider the Laparoscopic approach to abdominal peritonitis emergencies a safe and effective as conventional surgery, with a higher diagnostic yield and allows for lesser trauma and a more rapid postoperative recovery. Such features make Laparoscopy a challenging alternative to open surgery in the management algorithm for abdominal peritonitis emergencies.
authors.affiliation: Department of General Surgery, Presidio Ospedaliero di Vittorio Veneto, Vittorio Veneto, (TV) Italy. fagresta@libero.it.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Agresta
authors.forename: Luigi Francesco
authors.initials: LF
authors.lastname: Ciardo
authors.forename: Giorgio
authors.initials: G
authors.lastname: Mazzarolo
authors.forename: Ivan
authors.initials: I
authors.lastname: Michelet
authors.forename: Guido
authors.initials: G
authors.lastname: Orsi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Trentin
authors.forename: Natalino
authors.initials: N
authors.lastname: Bedin