TÌNH HÌNH VÀ KẾT QUẢ ĐIỀU TRỊ VIÊM PHÚC MẠC DO THỦNG ỐNG TIÊU HÓA BẰNG PHẪU THUẬT NỘI SOI

Abstract

Background: Secondary peritonitis caused by gastrointestinal perforation is a severe surgical emergency with rapid progression and high mortality if not promptly treated. Laparoscopic surgery, with its advantages of minimal invasiveness, has increasingly been adopted for the management of this condition. Objectives: To describe the clinical characteristics and etiologies of peritonitis secondary to gastrointestinal perforation, and to evaluate the outcomes of emergency laparoscopic management. Materials and methods:  A non-controlled interventional clinical study was conducted on 122 patients diagnosed with peritonitis secondary to gastrointestinal perforation who underwent laparoscopic surgery at Can Tho Central General Hospital and An Giang General Hospital between May 2025 and December 2025. Results: The median age was 61.5 years (range: 17-91), with a male - to - female ratio of 3.88:1. The median Charlson Comorbidity Index (CCI) was 2 (range: 0-9). Surgery was performed more than 12 hours after symptom onset in 56.6% of patients. Free intraperitoneal air was detected in 57.4% of cases on upright plain abdominal radiography and in 88.1% on computed tomography. Leukocytosis was observed in 73.0% of patients. The most common perforation sites were the stomach and duodenum. The median perforation size was 10 mm (range: 0-30). Generalized peritonitis accounted for 89.3% of cases, and the median Mannheim Peritonitis Index (MPI) was 21 (range: 0-37). The median operative time was 80 minutes (range: 40-200). Primary closure of the perforation was performed in 93.4% of patients, with a conversion rate to open surgery of 9.0%. The median postoperative hospital stay was 7 days (range: 3-20). No postoperative complications were recorded in 82.0% of patients. Good and fair outcomes after 30 days of treatment were achieved in 79.5% and 13.9% of patients, respectively. Conclusions: Laparoscopic surgery is a feasible approach associated with favorable short-term outcomes in appropriately selected patients with peritonitis secondary to gastrointestinal perforation, when appropriately indicated and performed by an experienced surgical team.