Emergency Laparoscopy for Complex and Trauma Cases: Feasibility and Outcomes in Experienced Surgical Teams

Background Laparoscopy offers significant benefits over open surgery, including faster recovery, reduced postoperative pain, and fewer complications. However, its feasibility in emergency settings, particularly for complex and trauma-related cases, remains underexplored. Key determinants include surgical expertise, theater readiness, and patient selection. Methods This observational, cross-sectional study was conducted over a two-year period in two high-volume university hospitals, one of which is a designated major trauma center. A total of 112 patients undergoing emergency abdominal surgery by a single experienced surgeon were included. Data collected encompassed procedure type, conversion to open surgery, length of stay (LOS), complications, intensive care unit (ICU) admission, and 30-day mortality. Comparative analyses between laparoscopic and open approaches were performed using the Fisher-Irwin exact test. Results Among the 112 emergency surgeries, 95 (84.5%) were completed laparoscopically and 17 (15.2%) via open approach. The cohort included category I trauma cases (n=6, 6.3%) and complex conditions such as visceral perforations and bowel obstructions. The median patient age was 75 years, and the median postoperative LOS was five days. Only one laparoscopic case (0.9%) required conversion to open surgery. Diagnostic laparoscopy was also utilized for undifferentiated abdominal pain. Major complications occurred in two (1.7%) patients and required reoperation. ICU admission was necessary in 10 (9%) cases, and the 30-day mortality rate was 1.7% (n=2). Conclusion Laparoscopy appears to be a feasible and safe option for emergency abdominal surgery, even in complex and trauma-related cases, when performed by experienced surgeons within adequately equipped settings. The low conversion and complication rates observed in this series reflect the critical role of surgical expertise, team coordination, and appropriate patient selection. While minimally invasive surgery is increasingly becoming standard in many emergency procedures, its successful application in high-risk or complex scenarios remains heavily dependent on operator proficiency. Broader adoption of this approach requires targeted training and further validation through larger prospective studies.