Adrian Cotirlet, MD, PhD1, Marius Nedelcu, MD2, Laura Gavril3. 1Moinesti Emergency Hospital, 2Nouvel Hospital Civil, IRCAD, Strasbourg, 3Iasi University Hospital
Progress in laparoscopic experience has increased the number of laparoscopic procedures performed for nontraumatic abdominal emergencies. We present a retrospective study of the results of a 5-year experience at a single center with the intent to prove the safety and feasibility of laparoscopic approach in the treatment of acute abdomen.
Between January 2010 to December 2014, 4461 patients were treated via laparoscopy, including 1294 patients a provisional diagnosis of acute abdomen (29.01 %) The following variables were analyzed: the final diagnosis, the conversion rate, the morbidity, mortality and the hospital stay.
The final diagnosis was: 653 (50.46%) acute appendicitis; 421 (32.53%) acute cholecystitis; 52 (4.02%) gastroduodenal perforation; 146 (11.28%) gynecological emergency 22 (1.7%) small bowel obstruction. A definitive laparoscopic diagnosis was possible in over 98% of cases, and definitive treatment via laparoscopy was possible in 95.05 %. The conversion to laparotomy was needed in 64 cases: 42 (6.43%) appendectomies; 12 (2.85%) cholecystectomies; 4 (7.69%) gastroduodenal perforation; 4 (2.73%) gynecological emergency and 2 (9.09%) small bowel obstruction. The overall postoperative morbidity rate was 4.32% and mortality was recorded in 2 cases. The mean hospital stay was 5.4 days.
The benefits of the laparoscopic approach in abdominal emergency are represented by both high diagnostic accuracy and therapeutic options. Laparoscopy is safe and effective in treating gastrointestinal abdominal emergency with acceptable morbidity and low mortality rate. Compared with laparotomy, the laparoscopy offers the advantages of less trauma, faster recovery, shorter hospital stay, and lower postoperative complications rate for patients with acute abdomen.