LAPAROSCOPIC SURGERY: A PARADIGM SHIFT IN THE TREATMENT OF ACUTE ABDOMINAL EMERGENCIES
Keywords:
LAPAROSCOPIC SURGERY, EMERGENCY, CONVERSION RATES
Abstract
Introduction: Laparoscopic surgery has revolutionized the management of abdominal emergencies, offering a minimally invasive alternative with a history of skepticism that turned to widespread acceptance after the 1980s' technological advancements. Its adoption in emergencies draws from its elective success, touting reduced incision sizes, diminished pain, lower infection risks, and expedited recovery.
Material & Method: This retrospective study analyzed clinical records from Târgu Mureș County Clinical Emergency Hospital's General Surgery Department I over eight years. It focused on laparoscopic versus open surgical approaches for various abdominal emergencies, excluding thoracic, vascular, and traumatic cases. Data encompassed demographic details, operative duration, postoperative complications, conversion rates, and hospitalization length, analyzed using Graph Pad Prism and EasyMedStats©, with ethical oversight by SCJU Clinical Hospital Tg. Mures.
Results: Laparoscopic procedures outnumbered open surgeries, with appendicitis being the most common emergency. Notably, laparoscopic approaches saw fluctuating but generally declining admissions from 2014 to 2021, mainly due to the COVID-19 pandemic. Operative times were shorter for laparoscopy across all procedures, with hospital stays also reduced for laparoscopic methods except in incisional hernia repairs, where times were comparable. Conversion rates varied, with hernia repairs least likely to convert and appendectomies most likely.
Conclusion: The study underscores the preferential role of laparoscopy in emergency surgical care, aligning with shorter operative times and hospital stays. Despite higher conversion rates for certain conditions, the benefits of laparoscopy remain compelling. Ongoing advancements in laparoscopic technology will further solidify its pivotal role in modern surgical practice.
References
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2. Nassar, A.H.M., Zanati, H.E., Ng, H.J. et al. Open conversion in laparoscopic cholecystectomy and bile duct exploration: subspecialisation safely reduces the conversion rates. Surg Endosc 36, 550–558 (2022). https://doi.org/10.1007/s00464-021-08316-1
3. CholeS Study Group, West Midlands Research Collaborative (2016) Population-based cohort study of outcomes following cholecystectomy for benign gallbladder diseases. Br J Surg 103(12):1704–1715
4. Sartori A, Balla A, Botteri E, Scolari F, Podda M, Lepiane P, Guerrieri M, Morales-Conde S, Szold A, Ortenzi M. Laparoscopic approach in emergency for the treatment of acute incarcerated groin hernia: a systematic review and meta-analysis. Hernia. 2022 May 26. doi: 10.1007/s10029-022-02631-9. Epub ahead of print. PMID: 35618958.
5. Zanoni AAG, Delcarro A, Ciccarese F, Villa R, Oldani A, Giorgi R, Rubicondo C, Bonaldi M, Cesana G, Uccelli M, De Carli S, Ismail A, Ferrari D, Olmi S. Laparoscopic transperitoneal hernia repair (TAPP) in emergency: long-term follow-up in a high volume centre. Hernia. 2022 Aug;26(4):1063-1068. doi: 10.1007/s10029-021-02516-3. Epub 2021 Oct 18. PMID: 34661771.
6. Liu, J., Shen, Y., Nie, Y. et al. If laparoscopic technique can be used for treatment of acutely incarcerated/strangulated inguinal hernia?. World J Emerg Surg 16, 5 (2021). https://doi.org/10.1186/s13017-021-00348-1
7. Maia, Raquel A., Hrishikesh P. Salgaonkar, Davide Lomanto, & Lynette Loo. "Umbilical hernia: when and how." Annals of Laparoscopic and Endoscopic Surgery [Online], 4 (2019): n. pag. Web. 21 May. 2023
8. Shah RH, Sharma A, Khullar R, Soni V, Baijal M, Chowbey PK. Laparoscopic repair of incarcerated ventral abdominal wall hernias. Hernia. 2008 Oct;12(5):457-63. doi: 10.1007/s10029-008-0374-0. Epub 2008 May 6. PMID: 18459033.
9. Tartaglia, D., Strambi, S., Coccolini, F. et al. Laparoscopic versus open repair of perforated peptic ulcers: analysis of outcomes and identification of predictive factors of conversion. Updates Surg 75, 649–657 (2023). https://doi.org/10.1007/s13304-022-01391-6
10. Coe PO, Lee MJ, Boyd-Carson H, Lockwood S, Saha A. Open Versus Laparoscopic Repair of Perforated Peptic Ulcer Disease: A Propensity-matched Study of the National Emergency Laparotomy Audit. Ann Surg. 2022 May 1;275(5):928-932. doi: 10.1097/SLA.0000000000004332. Epub 2020 Nov 12. PMID: 33201117.
11. Sebastian-Valverde E, Poves I, Membrilla-Fernández E, Pons-Fragero MJ, Grande L. The role of the laparoscopic approach in the surgical management of acute adhesive small bowel obstruction. BMC Surg. 2019 Apr 24;19(1):40. doi: 10.1186/s12893-019-0504-x. PMID: 31014318; PMCID: PMC6480811.
12. Chihara N, Suzuki H, Sukegawa M, Nakata R, Nomura T, Yoshida H. Is the Laparoscopic Approach Feasible for Reduction and Herniorrhaphy in Cases of Acutely Incarcerated/Strangulated Groin and Obturator Hernia?: 17-Year Experience from Open to Laparoscopic Approach. J Laparoendosc Adv Surg Tech A. 2019 May;29(5):631-637. doi: 10.1089/lap.2018.0506. Epub 2018 Oct 27. PMID: 30372373.
13. Huang C, Shen JC, Zhang J, Jiang T, Wu WD, Cao J, Huang KJ, Qiu ZJ. Clinical comparison of laparoscopy vs open surgery in a radical operation for rectal cancer: A retrospective case-control study. World J Gastroenterol. 2015 Dec 28;21(48):13532-41. doi: 10.3748/wjg.v21.i48.13532. PMID: 26730165; PMCID: PMC4690183.
14. Biondi A, Di Stefano C, Ferrara F, Bellia A, Vacante M, Piazza L. Laparoscopic versus open appendectomy: a retrospective cohort study assessing outcomes and cost-effectiveness. World J Emerg Surg. 2016 Aug 30;11(1):44. doi: 10.1186/s13017-016-0102-5. PMID: 27582784; PMCID: PMC5006397.
15. Nazir A, Farooqi SA, Chaudhary NA, Bhatti HW, Waqar M, Sadiq A. Comparison of Open Appendectomy and Laparoscopic Appendectomy in Perforated Appendicitis. Cureus. 2019 Jul 9;11(7):e5105. doi: 10.7759/cureus.5105. PMID: 31523536; PMCID: PMC6728774.
16. Maia, Raquel A., Hrishikesh P. Salgaonkar, Davide Lomanto, & Lynette Loo. "Umbilical hernia: when and how." Annals of Laparoscopic and Endoscopic Surgery [Online], 4 (2019): n. pag. Web. 21 May. 2023
17. Li, Ping MDa; Han, Yan MDb; Yang, Yang MDc; Guo, Hongjie MDc; Hao, Fabao MDc; Tang, Yan BNc,*; Guo, Chunbao MD, PhDc,d,*. Retrospective review of laparoscopic versus open surgery in the treatment of appendiceal abscess in pediatric patients: Laparoscopic versus open surgery for appendiceal abscess. Medicine 96(30):p e7514, July 2017. | DOI: 10.1097/MD.0000000000007514
18. Rasuli, S. F., Naz, J., Azizi, N., Hussain, N., Qureshi, P. N. A. A., Swarnakari, K. M., Dost, W., Zafar, S., Qadar, L. T., & Talpur, A. S. (2022, June 23). Laparoscopic Versus Open Appendectomy for Patients With Perforated Appendicitis. Cureus. https://doi.org/10.7759/cureus.26265
19. Coe PO, Lee MJ, Boyd-Carson H, Lockwood S, Saha A. Open Versus Laparoscopic Repair of Perforated Peptic Ulcer Disease: A Propensity-matched Study of the National Emergency Laparotomy Audit. Ann Surg. 2022 May 1;275(5):928-932. doi: 10.1097/SLA.0000000000004332. Epub 2020 Nov 12. PMID: 33201117.
20. Ribeiro, Ulysses Jr MD, PhDa; Tayar, Daiane Oliveira MD, PhDb,∗; Ribeiro, Rodrigo Antonini MD, PhDc; Andrade, Priscila PharmD, MPHb; Junqueira, Silvio Mauro Jr MD, MBAb. Laparoscopic vs open colorectal surgery: Economic and clinical outcomes in the Brazilian healthcare. Medicine 99(42):p e22718, October 16, 2020. | DOI: 10.1097/MD.0000000000022718
21. Ribeiro, Ulysses Jr MD, PhDa; Tayar, Daiane Oliveira MD, PhDb,∗; Ribeiro, Rodrigo Antonini MD, PhDc; Andrade, Priscila PharmD, MPHb; Junqueira, Silvio Mauro Jr MD, MBAb. Laparoscopic vs open colorectal surgery: Economic and clinical outcomes in the Brazilian healthcare. Medicine 99(42):p e22718, October 16, 2020. | DOI: 10.1097/MD.0000000000022718
22. Walsh, C. A., Tang, T. Y., & Walsh, S. R. (2008, August 1). Laparoscopic versus open appendicectomy in pregnancy: A systematic review. International Journal of Surgery. https://doi.org/10.1016/j.ijsu.2008.01.006
23. Di Saverio, S., Podda, M., De Simone, B., Ceresoli, M., Augustin, G., Gori, A., Boermeester, M. A., Sartelli, M., Coccolini, F., Tarasconi, A., De Angelis, N., Weber, D., Tolonen, M., Birindelli, A., Biffl, W. L., Moore, E. E., Kelly, M. E., Søreide, K., Kashuk, J. L., . . . Catena, F. (2020, April 15). Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World Journal of Emergency Surgery. https://doi.org/10.1186/s13017-020-00306-3
24. Wang, D., Dong, T., Shao, Y., Gu, T., Xu, Y., & Jiang, Y. (2019, May 28). Laparoscopy versus open appendectomy for elderly patients, a meta-analysis and systematic review. BMC Surgery. https://doi.org/10.1186/s12893-019-0515-7
25. Lee, S. H., Lee, J. Y., Choi, Y. Y., & Lee, J. G. (2019, April 25). Laparoscopic appendectomy versus open appendectomy for suspected appendicitis during pregnancy: a systematic review and updated meta-analysis. BMC Surgery. https://doi.org/10.1186/s12893-019-0505-9
26. Jackson, H. H., Granger, S. R., Price, R. R., Rollins, M. D., Earle, D., Richardson, W., & Fanelli, R. D. (2008, June 14). Diagnosis and laparoscopic treatment of surgical diseases during pregnancy: an evidence-based review. Surgical Endoscopy and Other Interventional Techniques. https://doi.org/10.1007/s00464-008-9989-6
27. de Kok HJ. A new technique for resecting the non-inflamed not-adhesive appendix through a mini-laparotomy with the aid of the laparoscope. Arch Chir Neerl. 1977;29(3):195-8. PMID: 144461.
28. Werkgartner, G., Cerwenka, H., Shabrawi, A. E., Bacher, H., Häuser, H., Mischinger, H. J., Wagner, M., & Wagner, D. (2014, December 16). Laparoscopic versus open appendectomy for complicated appendicitis in high risk patients. International Journal of Colorectal Disease. https://doi.org/10.1007/s00384-014-2095-4
29. Agresta, F., Ansaloni, L., Baiocchi, G. L., Bergamini, C., Campanile, F. C., Carlucci, M., Cocorullo, G., Corradi, A., Franzato, B., Lupo, M., Mandalà, V., Mirabella, A., Pernazza, G., Piccoli, M., Staudacher, C., Vettoretto, N., Zago, M., Lettieri, E., Levati, A., . . . Garattini, S. (2012, June 27). Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell’Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surgical Endoscopy and Other Interventional Techniques. https://doi.org/10.1007/s00464-012-2331-3
30. Agrusa, A., Romano, G., Frazzetta, G., Chianetta, D., Sorce, V., Di Buono, G., & Gulotta, G. (2014, October 1). Role and outcomes of laparoscopic cholecystectomy in the elderly. International Journal of Surgery. https://doi.org/10.1016/j.ijsu.2014.08.385
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