**9. Conclusion**

Access by laparoscopy seems to be of advantage over laparotomy as a diagnostic and therapeutic method in the approach to peritonitis and sepsis of abdominal origin by involving a lower surgical trauma, by providing a good field of view of the peritoneal cavity and by permitting to obtain tissue and fluid samples under direct vision. The rate of unnecessary laparotomies can be reduced when laparoscopy is used for a diagnostic and therapeutic approach in cases of acute abdomen, even in the presence of peritonitis or sepsis of abdominal origin.

In the management of peritonitis by laparoscopy, the inflammatory response is milder compared to management by laparotomy. The elevation of inflammatory cytokines is moderate and macrophages present a better basal immunologic performance. In contrast to what occurs with laparotomy, the acute phase of the inflammatory response associated with perioperative sepsis is attenuated during laparoscopy, and the immune function seems to be better preserved after the latter.

Despite the doubts about the feasibility and efficiency of laparoscopy compared to laparotomy for the approach to peritonitis, minimally invasive surgery is gaining acceptance among surgeons, especially regarding patients with abdominal sepsis.
