title: Management of Peritonitis After Minimally Invasive Colorectal Surgery: Can We Stick to Laparoscopy?
abstract: BACKGROUND
  Although laparoscopy is becoming the standard of care for the treatment of colorectal disease, its application in case of postoperative peritonitis is still not widespread. The objective of this article is to evaluate the role of laparoscopy in the management of postoperative peritonitis after elective minimally invasive colorectal resection for malignant and benign diseases.
  
  
  METHODS
  Between April 2010 and May 2016, 536 patients received primary minimally invasive colorectal surgery at our Department. Among this series, we carried out a retrospective study of those patients who, having developed signs of peritonitis, were treated with a laparoscopic reintervention. Patient demographics, type of complication and of the main relaparoscopic treatment, and main outcomes of reoperation were recorded.
  
  
  RESULTS
  A total of 20 patients (3.7%) underwent relaparoscopy for the management of postoperative peritonitis, of which exact causes were detected by laparoscopy in 75% as follows: anastomotic leakage (n = 8, 40%), colonic ischemia (n = 2, 10%), iatrogenic bowel tear (n = 4, 20%), and other (n = 1, 5%). The median time between operations was 3.5 days (range, 2-8). The laparoscopic reintervention was tailored case by case and ranged from lavage and drainage to redo anastomosis with ostomy fashioning. Conversion rate was 10% and overall morbidity was 50%. No cases required additional surgery and 30-day mortality was nil. Three patients (15%) were admitted to intensive care unit for 24-hour surveillance.
  
  
  CONCLUSIONS
  Our experience suggests that in experienced hands and in hemodynamically stable patients, a prompt laparoscopic reoperation appears as an accurate diagnostic tool and an effective and safe option for the treatment of postoperative peritonitis after primary colorectal minimally invasive surgery.
authors: Department of General and Oncologic Surgery , ASO Santa Croce e Carle, Cuneo, Italy .
authors: Alessandra
authors: A
authors: Marano
authors: Department of General and Oncologic Surgery , ASO Santa Croce e Carle, Cuneo, Italy .
authors: Maria Carmela
authors: MC
authors: Giuffrida
authors: Department of General and Oncologic Surgery , ASO Santa Croce e Carle, Cuneo, Italy .
authors: Giorgio
authors: G
authors: Giraudo
authors: Department of General and Oncologic Surgery , ASO Santa Croce e Carle, Cuneo, Italy .
authors: Luca
authors: L
authors: Pellegrino
authors: Department of General and Oncologic Surgery , ASO Santa Croce e Carle, Cuneo, Italy .
authors: Felice
authors: F
authors: Borghi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000601:surgery*; D003082:Colectomy; D003106:Colon / Q000098:blood supply / Q000293:injuries; D003111:Colonic Polyps / Q000601:surgery; D015179:Colorectal Neoplasms / Q000601:surgery; D061887:Conversion to Open Surgery; D013505:Digestive System Surgical Procedures; D004239:Diverticulitis, Colonic / Q000601:surgery; D004322:Drainage / Q000009:adverse effects; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D065666:Mesenteric Ischemia / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010538:Peritonitis / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies
keywords: colorectal; laparoscopy; postoperative peritonitis; relaparoscopy; robotic