Laparoscopic Management of Fecal Peritonitis

Luay D. Ailabouni, MD, Anjali S. Kumar, MD, MPH

Video Summary

Minimally invasive approaches to elective colon cases have increasingly become an optimal standard for the management of various colon pathologies, although widespread adoption is still slow. Our community of colon and rectal surgeons (with the welcome addition of new graduates of our training programs that emphasize minimally approaches at an ever-increasing rate) is boasting improved proficiency in performing minimally invasive surgery (MIS) as the first-line approach to all elective colorectal surgical conditions. Minimally invasive surgery in elective surgery is touted as superior in practice because of the marked benefit in patient-related outcomes (versus open surgery).

It has been our practice, over the past 5 years, to incorporate MIS in the management of not only elective cases, but also emergencies related to colon and rectal pathologies. In the case of free air and fecal peritonitis, the knee-jerk response for centuries has been laparotomy. However, we have found that an initial attempt at MIS has provided surprisingly positive results. Over time, we have faced many challenges resulting in the conversion to open surgery. Ultimately, we have been able to refine our technique to the steps described in the video to safely retain an MIS approach.


Teaching Points

  1. Approaching challenging cases in a systematic, step-by-step fashion is key to achieving a successful operation.
  2. Set yourself up for success in the reversal surgery by making sure to limit the dissection to the minimum needed to complete the initial operation or the Hartmann procedure.
  3. Familiarizing yourself with the different approaches to laparoscopic colon mobilization and resection during elective cases will help you during an emergency situation.
Last updated: December 6, 2022