Laparoscopy in the emergency setting: a retrospective review of 540 patients with acute abdominal pain.
BACKGROUND
Laparoscopy has been widely accepted among surgeons for the diagnosis and management of acute abdominal conditions. In this study, we aim to evaluate and summarize the experience in laparoscopic procedures, both diagnostic and interventional, for emergency nontraumatic abdominal conditions, in a tertiary academic center.


METHODS
From June 2005 to June 2009, a total of 1414 patients were subjected to a variety of emergency procedures at the university hospital of Patras and 540 of these patients were managed laparoscopically (38.2%). Indications for operations in the laparoscopic group were abdominal pain mimicking appendicitis in 229 patients (42.4%), acute cholecystitis in 248 patients (45.9%), gastroduodenal perforated ulcer in 14 patients (2.6%), small bowel obstruction in 24 patients (4.4%), and nonspecific abdominal pain in 25 patients (4.6%).


RESULTS
Diagnosis was established in 530 patients (98.2%) and definitive laparoscopic treatment was offered to 514 patients (95.2%). The conversion rate was 2.2%. Total mortality was 1.1% and total morbidity was 7.9%.


CONCLUSIONS
Laparoscopic approach to abdominal emergency provides high diagnostic accuracy and therapeutic options. Surgical experience, optimal procedural timing, and appropriate patient selection criteria diminish perioperative mortality and morbidity, and are associated with nominal conversion.
Karamanakos
Stavros N
SN
Department of Surgery, School of Medicine, University of Patras, Rion University Hospital, Patras, Greece.
Sdralis
Elias
E
Panagiotopoulos
Spyros
S
Kehagias
Ioannis
I
D000006:Abdomen, Acute / Q000175:diagnosis* / Q000601:surgery*; D000328:Adult; D000368:Aged; D001064:Appendicitis / Q000175:diagnosis; D041881:Cholecystitis, Acute / Q000175:diagnosis; D003937:Diagnosis, Differential; D004630:Emergencies; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis; D010535:Laparoscopy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000175:diagnosis; D012189:Retrospective Studies