Feasibility and outcomes of laparoscopic management in perforation peritonitis: A prospective cohort study with propensity score matching.

Background: Perforation peritonitis remains a significant cause of morbidity and mortality in emergency surgical patients. Conventionally, open laparotomy has been the preferred approach. However, with advancements in minimally invasive techniques, laparoscopic management has emerged as a potential alternative. The study aims to assess the feasibility and effectiveness of laparoscopic surgery compared to open laparotomy in managing perforation peritonitis.

Patients and methods: A prospective observational study was conducted from January 2022 to May 2023 for patients diagnosed with perforation peritonitis. A total of 140 patients were recruited, 110 patients underwent laparotomy while 30 patients underwent laparoscopic management. Propensity score matching (PSM) in 1:1 ratio was applied to balance confounding variables, resulting in two matched groups of 28 patients each. Operative time, length of post-operative stay, post-operative Visual Analogue Scale score, morbidity and mortality rates were compared.

Results: The mean operative time was significantly longer in the laparoscopic group (217.43 ± 86.10 min) compared to the laparotomy group (182.46 ± 31.63 min; P = 0.049). However, patients in the laparoscopic group experienced a significantly shorter hospital stay (4.39 ± 2.04 days vs. 8.68 ± 3.45 days; P < 0.001) and lower post-operative pain scores at all time points (P < 0.012). The 30-day morbidity rate was lower in the laparoscopic group (10% vs. 32%), with fewer surgical site infections and reoperations.

Conclusion: Laparoscopy is a feasible and effective alternative to laparotomy in selected cases of perforation peritonitis, offering benefits such as reduced post-operative pain and shorter hospital stay. Despite technical challenges, improved surgical expertise and patient selection can enhance its role in emergency surgical settings.