[Emergency laparoscopic surgery: a hospital's experience]

The wide diffusion and increasing use of laparoscopic surgery prompts the authors to broaden discussion to its validity and diagnostic-therapeutic use in emergency abdominal surgery. The aim was to evaluate the efficacy of laparoscopic surgery in the light of reports in the international literature and in relation to the situation in our hospital.

From April 1994 to May 1998, out of 1016 emergency abdominal operations performed at our hospital, 783 (77.5%) used a laparoscopic approach for diagnostic and therapeutic purposes: intestinal occlusion: 26 cases; gastrointestinal ulcer pathology: 15 cases; hepatobiliary pathology: 398 cases; "pelvic" pathology: 305 cases; colic pathology: 39 cases. These represent 24.4% of all laparoscopic procedures carried out during the same period. We preferred to use immediate laparotomic access in patients with the following characteristics: anamnesis of previous surgery for malignant pathologies; anamnesis of more than two major abdominal operations; massive intestinal distension; patients whose general conditions were a contraindication to a laparoscopic approach.

The conversion rate was 6.2% (49 cases) with morbidity of 3.4% (25 cases) and a mortality rate of 0.2% (2 cases). A final diagnosis was made in 763 patients (97.4%) with the possibility of treating 719 of them (94.2%), again using a laparoscopic approach.

It is right to regard the laparoscopic approach in emergency abdominal surgery as a feasible and safe model, offering a high potential for diagnosis and therapy if appropriately performed by an expert and well coordinated team. The increased experience of mini-invasive surgery and the improved range of instruments available make the laparoscopic approach a valid alternative to laparotomy, even in the event of emergency abdominal pathologies.