title: Current status of laparoscopy for acute abdomen in Italy: a critical appraisal of 2012 clinical guidelines from two consecutive nationwide surveys with analysis of 271,323 cases over 5 years.
abstract: Several authors have demonstrated the safety and feasibility of laparoscopy in selected cases of abdominal emergencies. The aim of the study was to analyse the current Italian practice on the use of laparoscopy in abdominal emergencies and to evaluate the impact of the 2012 national guidelines on the daily surgical activity.
  
  
  
  Two surveys (42 closed-ended questions) on the use of laparoscopy in acute abdomen were conducted nationwide with an online questionnaire, respectively, before (2010) and after (2014) the national guidelines publication. Data from two surveys were compared using Chi-square or Fisher's exact test, and data were considered significant when p < 0.05.
  
  
  
  Two-hundred and one and 234 surgical units answered to the surveys in 2010 and 2014, respectively. Out of 144,310 and 127,013 overall surgical procedures, 23,407 and 20,102, respectively, were abdominal emergency operations. Respectively 24.74 % (in 2010) versus 30.27 % (in 2014) of these emergency procedures were approached laparoscopically, p = 0.42. The adoption of laparoscopy increased in all the considered clinical scenarios, with statistical significance in acute appendicitis (44 vs. 64.7 %; p = 0.004). The percentage of units approaching Hinchey III acute diverticulitis with laparoscopy in 26-75 % of cases (14.0 vs. 29.7 %; p = 0.009), those with >25 % of surgeons confident with laparoscopic approach to acute diverticulitis (29.9 vs. 54 %; p = 0.0009), the units with >50 % of surgeons confident with laparoscopic approach to acute appendicitis, cholecystitis and perforated duodenal ulcer, all significantly increased in the time frame. The majority of respondents declared that the 2012 national guidelines influenced their clinical practice.
  
  
  
  The surveys showed an increasing use of laparoscopy for patients with abdominal emergencies. The 2012 national guidelines profoundly influenced the Italian surgical practice in the laparoscopic approach to the acute abdomen.
authors: Department of General Surgery, ULSS19 del Veneto, Adria, RO, Italy.
authors: Ferdinando
authors: F
authors: Agresta
authors: Division of Surgery, Ospedale San Giovanni Decollato - Andosilla, Civita Castellana, VT, Italy.
authors: Fabio Cesare
authors: FC
authors: Campanile
authors: Department of Surgical Science, University of Cagliari - General, Emergency and Laparoscopic Surgery - SS 554, Km 4.500, Monserrato, CA, Italy.
authors: Mauro
authors: M
authors: Podda
authors: UOC Chirurgia Generale PO SS. Trinità ASL8CA, Via Is Mirrionis 92, 09121, Cagliari, Italy.
authors: Nicola
authors: N
authors: Cillara
authors: General Surgery 1 Unit, Surgical Sciences Department, AO San Giovanni Addolorata, Rome, Italy.
authors: Graziano
authors: G
authors: Pernazza
authors: General Surgery Unit, Department of Surgical and Medical Sciences and Translational Medicine, Sant'Andrea Hospital, 'Sapienza' University of Rome, Rome, Italy.
authors: Valentina
authors: V
authors: Giaccaglia
authors: UOC Chirurgia Generale PO Santa Maria della Stella Loc. Ciconia, 05018, Orvieto, TR, Italy.
authors: Luigi
authors: L
authors: Ciccoritti
authors: ASST Bergamo EST - Bolognini Seriate, Seriate, Italy.
authors: Giovanna
authors: G
authors: Ioia
authors: Unit of General Surgery, Noto-Pasqualino Hospital, Via Dante Alighieri n 330, 90141, Palermo, Italy.
authors: Stefano
authors: S
authors: Mandalà
authors: Unit of General Surgery, Noto-Pasqualino Hospital, Via Dante Alighieri n 330, 90141, Palermo, Italy.
authors: Camillo
authors: C
authors: La Barbera
authors: S. Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy.
authors: Arianna
authors: A
authors: Birindelli
authors: Department of Surgery, Macerata Hospital, Macerata, Italy.
authors: Massimo
authors: M
authors: Sartelli
authors: General, Emergency and Trauma Surgery Service, Maggiore Hospital Regional Trauma Center, AUSL Bologna, l.go Nigrisoli 2, 40100, Bologna, Italy. salo75@inwind.it.
authors: Salomone
authors: 0000-0001-5685-5022
authors: S
authors: Di Saverio
mesh_terms: D000006:Abdomen, Acute / Q000601:surgery*; D004630:Emergencies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*
keywords: Abdominal emergencies; Acute abdomen; Clinical audit; Emergency laparoscopy guidelines; Laparoscopic acute care surgery; Laparoscopic surgery; Laparoscopy; Laparoscopy acute abdomen; National survey; Nationwide survey on laparoscopy