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Abdominal emergencies: diagnostic and therapeutic laparoscopy
1Department of Surgery, United Arab Emirates University, Al Ain, United Arab Emirates. f.branicki@uaeu.ac.ae
Surgical Infections
|January 25, 2003
Summary
Laparoscopy offers benefits for acute abdominal conditions like biliary disease and appendicitis, but evidence is still developing for wider emergency use. Further research is needed to address concerns regarding sepsis and patient outcomes.
Area of Science:
- Minimally invasive surgery
- Surgical innovation
- Emergency medicine
Background:
- Laparoscopy is used for various acute abdominal emergencies, including inflammation, obstruction, perforation, vascular issues, and trauma.
- Controversies exist regarding laparoscopy's efficacy, cost-effectiveness, and advantages in acute abdominal conditions.
Purpose of the Study:
- To identify and discuss controversial aspects of laparoscopy in the evaluation and treatment of acute abdominal conditions.
- To review current evidence and expert opinion on laparoscopic surgery in emergency settings.
Main Methods:
- A review and commentary on relevant English-language literature.
- Analysis of prospective randomized trials and experimental studies.
Main Results:
- Evidence-based recommendations are lacking, hindering widespread emergency laparoscopic use.
- Concerns exist about capnoperitoneum potentially worsening bacteremia and sepsis in peritonitis, with conflicting experimental data.
- Laparoscopy is preferred for acute biliary disease and may benefit select female patients with appendicitis.
Conclusions:
- Increased laparoscopic utilization is expected with greater expertise and resolution of current issues.
- Minimal-access surgery offers reduced morbidity and practical advantages.
- Laparoscopy is suitable for acute biliary disease, select appendicitis cases, and early-stage, stable intestinal obstruction/perforation. It is not recommended for trauma, generalized peritonitis, or hemodynamic instability.