Minimally invasive surgical technologies in the treatment of postoperative peritonitis: efficacy analysis and tactical selection criteria

Postoperative peritonitis remains one of the most severe complications in abdominal surgery, associated with high mortality rates (15-30%) and significant treatment costs. Despite advances in surgical techniques, its incidence persists at 1-5% following extensive abdominal operations. This study evaluates the efficacy of minimally invasive methods, particularly laparoscopy, in treating this complication and establishes criteria for selecting optimal surgical strategies. The study included 69 patients divided into two groups: a main group (n=46) undergoing laparoscopic interventions for diffuse peritonitis, and a control group (n=23) treated with traditional relaparotomy for localized forms. The results showed comparable timelines for repeat interventions (3.9 ± 2.9 days in the laparoscopic group vs. 4.1 ± 2.1 days in the relaparotomy group). However, nearly half of the repeat procedures (47.8%) in the laparoscopic group were performed within the first 48 hours, indicating earlier diagnosis of complications. Key criteria for selecting a laparoscopic approach were identified, including the absence of extensive fibrinous deposits, significant intestinal dilation, and the feasibility of a comprehensive abdominal cavity revision. Absolute indications for conversion to open surgery were also outlined, such as anastomotic leakage, intestinal perforation, mesenteric circulatory disorders, and severe inflammatory processes. Special emphasis was placed on laparoscopic abscess drainage techniques, including adhesiolysis and gravitational patient positioning to minimize the risk of infection spread. The study confirms that laparoscopy can be an effective alternative when strict patient selection criteria are applied. However, open surgery remains the preferred approach in complex cases. These findings hold significant practical value for surgeons, offering guidance for optimizing treatment strategies for postoperative peritonitis.