[Diagnostic and therapeutic value of laparoscopy in acute abdomen]

The purpose of this work is to evaluate the degree of applicability of the diagnostic laparoscopy (DL) and therapeutic laparoscopy in the acute abdomen and trauma patients. The material of 109 cases of DL performed since 1983 has been evaluated retrospectively. 22 patients were operated by laparoscopy. The patients were assessed in the following groups: I-suspected acute appendicitis, II-acute abdomen of uncertain ethology, III-abdominal trauma. In the first group 60 patients were diagnosed, 13 of them were operated by laparoscopy, 28 by open access, 15 avoided the unnecessary laparotomy. In the second group 30 patients were diagnosed, 6 of them were operated by laparoscopy, 8 open interventions were noted, 16 avoided the non-therapeutic laparotomy. In the third group 19 patients were diagnosed, 13 underwent laparotomy, 6 avoided the unnecessary intervention. There has been one death, not associated with DL (acute bowel ischemia), morbidity was 1% (one case of bleeding from the mesenterial artery, treated by conversion to laparotomy), one DL was considered as falsely negative, one not sufficient to establish the diagnosis. Basing on our experience in DL as a diagnostic tool we can confirm the accuracy of the method in 99.08% with only 1% of morbidity. 20.1% of patients were operated by laparoscopy, without complications. In conclusions the authors consider the DL allows to establish a prompt and accurate diagnosis in the acute abdomen and trauma without a therapeutic delay and unnecessary hospital observation. The fault of the method and morbidity rate is acceptable. The treatment by the same laparoscopic access offers to these patients another benefit, the more the experience is increasing.