The laparoscopic approach in abdominal emergencies: has the attitude changed? : A single-center review of a 15-year experience.
BACKGROUND
Laparoscopy has been practiced more and more in the management of abdominal emergencies. The aim of the present work was to illustrate retrospectively the results of a case-control 5-year experience of laparoscopic versus open surgery for abdominal emergencies carried out at our institution, especially with regard to whether our attitude toward use of this procedure has changed as compared with the beginning of our laparoscopic emergency experience (1991-2002).


METHODS
From January 2002 to January 2007 a total of 670 patients underwent emergent and/or urgent laparoscopy (small bowel obstruction, 17; gastroduodenal ulcer disease, 16; biliary disease, 118; pelvic disease and non-specific abdominal pain (NSAP), 512; colonic perforations, 7) at the hands of a surgical team trained in laparoscopy


RESULTS
The conversion rate was 0.15%. Major complications ranged as high as 1.9% with no postoperative mortality. A definitive diagnosis was accomplished in 98.3% of the cases, and all such patients were treated successfully by laparoscopy.


CONCLUSIONS
We believe that laparoscopy is not an alternative to physical examination/good clinical judgment or to conventional noninvasive diagnostic methods in treating the patient with symptoms of an acute abdomen. However it must be considered an effective option in treating patients in whom these methods fail and as a challenging alternative to open surgery in the management algorithm for abdominal emergencies.
Agresta
F
F
Department of General Surgery, Presidio Ospedaliero di Vittorio Veneto, Vittorio Veneto, TV, Italy. fagresta@libero.it
Mazzarolo
G
G
Ciardo
L F
LF
Bedin
N
N
D015746:Abdominal Pain / Q000453:epidemiology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000453:epidemiology / Q000601:surgery; D001291:Attitude of Health Personnel; D001649:Bile Duct Diseases / Q000453:epidemiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D002764:Cholecystitis / Q000453:epidemiology / Q000601:surgery; D003108:Colonic Diseases / Q000453:epidemiology / Q000601:surgery; D004638:Emergency Treatment / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D013502:General Surgery / Q000379:methods; D005831:Genital Diseases, Female / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000601:surgery; D007416:Intestinal Perforation / Q000453:epidemiology / Q000601:surgery; D007421:Intestine, Small / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000453:epidemiology / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult