Impact of laparoscopic approach in emergency major abdominal surgery: single-centre analysis of 748 consecutive cases

Pucher, Philip H.; Carter, N C; Knight, Benjamin; Toh, Simon; Tucker, Vanessa; Mercer, Stuart

doi:10.1308/rcsann.2017.0229

Cited by 34 publications

(22 citation statements)

References 16 publications

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“…The use of the laparoscopic approach in the emergency setting is well established and has some advantages to the open approach by reducing the postoperative pain, length of hospital stay and complication rates [21][22][23][24].…”

Section: Discussionmentioning

confidence: 99%

The use of emergency laparoscopy for acute abdomen in the elderly: the FRAILESEL Italian Multicenter Prospective Cohort Study

et al. 2020

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As the world population is aging rapidly, emergency abdominal surgery for acute abdomen in the elderly represents a global issue, both in developed and developing countries. Data regarding all the elderly patients who underwent emergency abdominal surgery from January 2017 to December 2017 at 36 Italian surgical departments were analyzed with the aim to appraise the contemporary reality regarding the use of emergency laparoscopy for acute abdomen in the elderly. 1993 patients were enrolled. 1369 (68.7%) patients were operated with an open technique; whereas, 624 (31.3%) underwent a laparoscopic operation. The postoperative morbidity rate was 32.6%, with a statically significant difference between the open and the laparoscopic groups (36.2% versus 22.1%, p < 0.001). The reported mortality rate was 8.8%, with a statistically significant difference between the open and the laparoscopic groups (11.2% versus 2.2%, p < 0.001). Our results demonstrated that patients in the ASA II (58.1%), ASA III (68.7%) and ASA IV (88.5%) groups were operated with the traditional open technique in most of the cases. Only a small percentage of patients underwent laparoscopy for perforated gastro-duodenal ulcer repair (18.9%), adhesiolyses with/without small bowel resection (12.2%), and large bowel resection (10.7%). Conversion to open technique was associated with a higher mortality rate (11.1% versus 2.2%, p < 0.001) and overall morbidity (38.9% versus 22.1%, p = 0.001) compared with patients who did not undergo conversion. High creatinine (p < 0.001) and glycaemia (p = 0.006) levels, low hemoglobin levels (p < 0.001), oral anticoagulation therapy (p = 0.001), acute respiratory failure (p < 0.001), presence of malignancy (p = 0.001), SIRS (p < 0.001) and open surgical approach (p < 0.001) were associated with an increased risk of postoperative morbidity. Regardless of technical progress, elderly patients undergoing emergency surgery are at very high risk for in-hospital complications. A detailed analysis of complications and mortality in the present study showed that almost 9% of elderly patients died after surgery for acute abdomen, and over 32% developed complications.

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Section: Discussionmentioning

confidence: 99%

The use of emergency laparoscopy for acute abdomen in the elderly: the FRAILESEL Italian Multicenter Prospective Cohort Study

et al. 2020

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“…We believe that, thanks to laparoscopy, a serious group of patients have been eluded from undergoing laparotomy. In their study, Pucher et al [9] reported that performing laparoscopy instead of emergency laparotomy decreases mortality, length of hospital stays and medical costs. No mortality and morbidity were observed in 83 patients who underwent diagnostic laparoscopy.…”

Section: Discussionmentioning

confidence: 99%

Role of Laparoscopy Procedure in the Diagnosis and Treatment of Traumatic Acute Abdomen

Kanlıöz¹

2019

Laparosc Endosc Surg Sci

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Introduction: The objective of this study was to analyze the role of laparoscopy in the diagnosis and treatment of traumatic acute abdomen. Materials and Methods: Cases of patients with traumatic acute abdomen from between 2009 and 2017 diagnosed with laparoscopy but not examination, laboratory tests, or radiological methods were reviewed. These were patients with unstable vital signs for whom time was critical. The patient demographic data, causes of acute abdomen, procedures applied, and duration of hospitalization were analyzed. Results: Of the total of 138 patients, the cause of admission was a traffic accident in 46 cases (33.33%), sharp object injury in 27 (19.56%), gunshot injury in 19 (13.76%), falling from a height in 16 (11.59%), work accident in 14 (10.14%), physical violence in 9 (6.92%), sports injury in 4 (2.89%), and an animal kick in 3 (2.17%). In all, 56 (40.58%) were female and 82 (59.42%) were male. The mean age was 27.45±9.81 years. Of the patients, 64 (46.38%) had only abdominal trauma, while 74 (53.62%) had multiple trauma. The procedures performed included 83 (60.14%) diagnostic laparoscopies, 30 (21.74%) laparoscopies with additional laparoscopic procedures, and 25 (18.11%) instances of post-laparoscopy open surgery. In the group, 113 (81.88%) were discharged after healing; morbidity and mortality were observed in 21 (15.22%) and 4 (2.89%), respectively. The mean hospital stay was 2.82±1.64 days in patients with only abdominal trauma and 4.34±2.08 days in those with multiple trauma. Conclusion: Laparoscopy contributes significantly to the diagnosis and treatment of selected patients.

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“…Five trusts who performed more than 10 colectomies per year did not attempt any cases laparoscopically. There is evidence of an increasing use of laparoscopy for major abdominal surgery over time [19,20], and the variation in use of laparoscopy is similar to other emergency procedures such as emergency appendicectomy [21,22] as well as elective procedures performed in the UK [23].…”

Section: Discussionmentioning

confidence: 99%

An audit of process and outcome for emergency colectomy in England and Wales

Burns

Poulton²,

Pinkney

et al. 2020

Colorectal Disease

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Aim The aim of this work was to describe process and outcome for patients undergoing emergency colectomy for colitis in England and Wales. Method The National Emergency Laparotomy Audit (NELA) is a national audit including patients undergoing emergency laparotomy and laparoscopic resectional procedures. Data from adult patients under 65 years of age who underwent emergency subtotal colectomy or panproctocolectomy for colitis between 2013 and 2016 were analysed. Results In total 1204 patients were included. Although approximately a third of patients underwent a colectomy within 5 days of admission [37% (440/1204)], 32% (383/1204) were admitted for more than 10 days prior to surgery. Colorectal surgeons were present at operation in 72% (869/1204) of cases and consultant surgeons attended 94% (1137/1204) of procedures. Laparoscopy was attempted in 32% (390/1204) of operations with wide institutional variation in its use (0-100% of cases). The overall 30-day inpatient mortality was 2.9% (35/1204). On multivariable regression analysis, age > 55 years [OR 3.59 (1.05-12.21), P = 0.041], female gender [OR 2.88 (1.27-6.52), P = 0.011] and American Society of Anesthesiologists grade 5 [OR 37.43 (2.72-514.52), P = 0.007] were associated with increased mortality. Conclusion There is a consultant-driven service that is largely delivered by specialist colorectal surgeons. Laparoscopy rates were high although there was wide variation in use across institutions. Preoperative delays were evident, and further work is necessary to determine the underlying reasons for these.

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Impact of laparoscopic approach in emergency major abdominal surgery: single-centre analysis of 748 consecutive cases

Cited by 34 publications

References 16 publications

The use of emergency laparoscopy for acute abdomen in the elderly: the FRAILESEL Italian Multicenter Prospective Cohort Study

The use of emergency laparoscopy for acute abdomen in the elderly: the FRAILESEL Italian Multicenter Prospective Cohort Study

Role of Laparoscopy Procedure in the Diagnosis and Treatment of Traumatic Acute Abdomen

An audit of process and outcome for emergency colectomy in England and Wales

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