[Laparoscopy in abdominal emergencies. Indications and limitations].
Laparoscopy, which has been well known as a diagnostic procedure for more than a century, has recently established itself as an important therapeutic procedure in several branches of surgery. In the present study the authors report on 221 patients over a 10-year period (1991-2001), admitted to hospital with a diagnosis of acute abdomen or abdominal trauma. All patients were submitted to emergency laparoscopic surgery; 128 patients (57%) presented acute appendicitis, 40 (18%) acute cholecystitis, 13 (6%) occlusive ileus, 10 (5%) adnexal pathologies, 9 (4%) perforation of abdominal viscera, 3 (1.4%) acute diverticulitis, 3 (1.4%) subdiaphragmatic abscesses, 3 (1.4%) intestinal infarction, 2 (0.8%) other diseases and 10 (5%) abdominal trauma. The operation was completed laparoscopically in 192 cases (87%), while conversion to laparotomy proved necessary in 29 cases (13%). The morbidity of the cases completed laparoscopically was 3%, the mortality 0.5%, and the mean hospital stay 4 days. Advantages of laparoscopy (shorter hospital stay, rapid postoperative recovery and faster return to social activities) emerge from the present study and are confirmed by the literature. The possibility of combining a diagnostic procedure with curative therapy suggests that laparoscopy may have an important role in emergency surgery, demonstrating its efficacy also in acute abdominal syndromes. Nevertheless, emergency laparoscopic surgery is still a technically difficult procedure that needs to be performed by an expert surgical team.
Perri
Sergio G
SG
Cattedra e Scuola di Specializzazione in Chirurgia Generale, Università degli Studi di L'Aquila.
Altilia
Francesco
F
Pietrangeli
Francesco
F
Dalla Torre
Andrea
A
Gabbrielli
Francesco
F
Amendolara
Mauro
M
Nicita
Antonio
A
Nardi
Mario
M
Lotti
Roberto
R
Citone
Giorgio
G
D000006:Abdomen, Acute / Q000601:surgery*; D000007:Abdominal Injuries / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000379:methods; D002648:Child; D002764:Cholecystitis / Q000601:surgery; D004630:Emergencies; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery; D007416:Intestinal Perforation / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010052:Ovariectomy / Q000379:methods; D020535:Video-Assisted Surgery / Q000009:adverse effects / Q000379:methods*