Diagnostic laparoscopy for the acute abdomen and trauma

Background: We set out to investigate the potential benefits of routine dia gnostic laparoscopy (DL) in cases of acute abdomen. Methods: A prospective study of 120 DL in acute abdominal cases was perform ed in comparison with 310 similar acute abdominal cases treated without DL. The diagnostic accuracy, hospital stay, therapeutic delay, and convalescen ce time were then evaluated. Results: DL established the indications for intervention in 96% of cases, y ielded a diagnosis in 90%, and changed the treatment in 14%. The sensitivit y achieved was 99.3%, specificity was 83.3%, and accuracy was 88.6%. There were two false positives, one false negative, and three results insufficien t to make a diagnosis. Morbidity was one (0.8%), and mortality was one (0.8 %). Seventy-nine patients (66%) were managed by laparoscopy and 24 by open interventions. The hospital stay in DL groups was shorter (median, 5 days v s 6 days in controls, p<0.0003), as was the effective treatment time (media n, 5 days vs 6 days, p<0.0012). The convalescence time was also shorter in DL groups (median, 14 days vs 14 days, p<0.04). Therapeutic delay occurred in 16% of the control group cases, doubling the morbidity rate, increasing mortality by 50%, and prolonging hospital stay (median, 9 days vs 6 days, p >0.3 (NS). Conclusions: DL in the acute abdomen is a safe and accurate procedure that enables laparoscopic interventions and helps avoid nontherapeutic surgery. DL and appropriate treatment reduces hospital stay, therapeutic delay, and convalescence time.