Emergency laparoscopy - A community hospital experience

Background: By now, laparoscopic surgery has achieved widespread acceptance among surgeons and, generally speaking, by the public. Therefore, we set o ut to evaluate whether this technique is a feasible method of treating pati ents with abdominal emergencies, traumatic or not. To assess the routine us e of emergency laparoscopy in a community hospital setting, we undertook a retrospective analysis of an unrandomized experience (presence or absence o f a surgeon with laparoscopic experience). Methods: Between January 1993 and October 1998, 575 emergency abdominal sur gical procedures were done in our department. In all, 365 (63.4%) were diag nostic and operative laparoscopy procedures (acute small bowel obstruction: 23 cases; hernia disease: one case; gastroduodenal ulcer disease: 15 cases ; biliary system disease: 89 cases; pelvic disease: 237 cases). These cases represent almost 56% of all laparoscopic procedures done during the same p eriod at our institution. Laparoscopy was not performed in patients with a history of a previous abdominal approach to malignant disease, a history of more than two major abdominal surgeries, or massive bowel distension; nor was it used in patients whose general conditions contraindicate this approa ch. Results: The conversion rate was 6.8%. The morbidity and mortality rates we re, respectively, 4.1% and 0.8%. A definitive diagnosis was provided in 95. 3% of cases, with the possibility to treat 88.2% of them by laparoscopy. Conclusions: We consider the laparoscopic approach in patients with abdomin al emergencies to be feasible and safe in experienced hands. It provides di agnostic accuracy as well as therapeutic capabilities. Sparing patients lap arotomy reduces postoperative pain, improves recovery of GI function, reduc es hospitalization, cuts health care costs, and improves cosmetic results. This approach premises to play a significant role in emergency abdominal si tuations and will certainly become increasingly important in today's health care environment.