Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d'Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell'Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES).
BACKGROUND
In January 2010, the SICE (Italian Society of Endoscopic Surgery), under the auspices of the EAES, decided to revisit the clinical recommendations for the role of laparoscopy in abdominal emergencies in adults, with the primary intent being to update the 2006 EAES indications and supplement the existing guidelines on specific diseases.


METHODS
Other Italian surgical societies were invited into the Consensus to form a panel of 12 expert surgeons. In order to get a multidisciplinary panel, other stakeholders involved in abdominal emergencies were invited along with a patient's association. In November 2010, the panel met in Rome to discuss each chapter according to the Delphi method, producing key statements with a grade of recommendations followed by commentary to explain the rationale and the level of evidence behind the statements. Thereafter, the statements were presented to the Annual Congress of the EAES in June 2011.


RESULTS
A thorough literature review was necessary to assess whether the recommendations issued in 2006 are still current. In many cases new studies allowed us to better clarify some issues (such as for diverticulitis, small bowel obstruction, pancreatitis, hernias, trauma), to confirm the key role of laparoscopy (such as for cholecystitis, gynecological disorders, nonspecific abdominal pain, appendicitis), but occasionally previous strong recommendations have to be challenged after review of recent research (such as for perforated peptic ulcer).


CONCLUSIONS
Every surgeon has to develop his or her own approach, taking into account the clinical situation, her/his proficiency (and the experience of the team) with the various techniques, and the specific organizational setting in which she/he is working. This guideline has been developed bearing in mind that every surgeon could use the data reported to support her/his judgment.
Department of General Surgery, Presidio Ospedaliero di Adria, Piazza degli Etruschi, 9, 45011 Adria, RO, Italy. fagresta@libero.it
Ferdinando
F
Agresta
Luca
L
Ansaloni
Gian Luca
GL
Baiocchi
Carlo
C
Bergamini
Fabio Cesare
FC
Campanile
Michele
M
Carlucci
Giafranco
G
Cocorullo
Alessio
A
Corradi
Boris
B
Franzato
Massimo
M
Lupo
Vincenzo
V
Mandalà
Antonino
A
Mirabella
Graziano
G
Pernazza
Micaela
M
Piccoli
Carlo
C
Staudacher
Nereo
N
Vettoretto
Mauro
M
Zago
Emanuele
E
Lettieri
Anna
A
Levati
Domenico
D
Pietrini
Mariano
M
Scaglione
Salvatore
S
De Masi
Giuseppe
G
De Placido
Marsilio
M
Francucci
Monica
M
Rasi
Abe
A
Fingerhut
Selman
S
Uranüs
Silvio
S
Garattini
D000006:Abdomen, Acute / Q000601:surgery*; D000758:Anesthesia / Q000379:methods; D004066:Digestive System Diseases / Q000601:surgery*; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D065666:Mesenteric Ischemia; D008991:Monitoring, Physiologic; D009765:Obesity / Q000150:complications; D018579:Patient Selection; D011175:Positive-Pressure Respiration; D011187:Posture; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D012143:Respiratory Physiological Phenomena; D014652:Vascular Diseases / Q000601:surgery*