Feasibility and Outcome of Laparoscopic Approach for Acute Generalized Peritonitis in Africa: Single Low-Center Results After 25 Consecutive Cases in Cameroon

Peritonitis is a quite common surgical emergency. For this condition, many reports have shown that laparoscopic surgery is associated with lower morbidity and mortality. However, the laparoscopic approach to the management of peritonitis remains marginalized in low and middle-income countries (LMICs) due to financial and technical limitations. We conducted a seven-year prospective study on patients with acute generalized peritonitis in Yaoundé, Cameroon. Inclusion criteria were an age range of between 5 to 55 years, admission within 48 hours after the onset of symptoms, hemodynamic stability, and no major comorbidities. Excluded from this study were patients with colonic perforation, prior history of abdominal surgery, or primary and localized peritonitis after proper resuscitation. The patients included were managed via laparoscopy; operative and postoperative data were collected and analyzed. Some technical artifices were used to circumvent the lack of standard equipment. The study involved twenty-five patients with a mean age of 32.1 years. The etiology of peritonitis was identified as appendicitis in 20 cases, perforated duodenal ulcer in 2 cases, gastric ulcer perforation in 2 cases, and jejunal perforation in 1 case. In two cases (8%), the operation was converted to laparotomy. The postoperative course was uneventful in 21 cases (84%), whereas morbidity was seen in 4 cases (16%); no mortality was recorded. The mean length of hospital stay was 5.5 days. This study demonstrates that the laparoscopic management of acute generalized peritonitis in African LMICs is a feasible, safe, and effective surgical option in properly selected patients.