Laparoscopic approach in gastrointestinal emergencies

Abstract

This review focuses on the laparoscopic approach to gastrointestinal emergencies and its more recent indications. Laparoscopic surgery has a specific place in elective procedures, but that does not apply in emergency situations. In specific emergencies, there is a huge range of indications and different techniques to apply, and not all of them are equally settle. We consider that the most controversial points in minimally invasive procedures are indications in emergency situations due to technical difficulties. Some pathologies, such as oesophageal emergencies, obstruction due to colon cancer, abdominal hernias or incarcerated postsurgical hernias, are nearly always resolved by conventional surgery, that is, an open approach due to limited intraabdominal cavity space or due to the vulnerability of the bowel. These technical problems have been solved in many diseases, such as for perforated peptic ulcer or acute appendectomy for which a laparoscopic approach has become a well-known and globally supported procedure. On the other hand, endoscopic procedures have acquired further indications, relegating surgical solutions to a second place; this happens in cholangitis or pancreatic abscess drainage. This endoluminal approach avoids the need for laparoscopic development in these diseases. Nevertheless, new instruments and new technologies could extend the laparoscopic approach to a broader array of potentials procedures. There remains, however, a long way to go.

Comparison of laparoscopic surgery versus traditional laparotomy for the treatment of emergency patients

“…These illnesses share clinical characteristics including acute onset, severe abdominal pain, and symptoms of diarrhea, nausea, and vomiting. 1 Cases can become life-threatening in the absence of immediate proper treatment, which generally entails traditional laparotomy. However, such treatment is inevitably associated with significant disadvantages including a large wound and prolonged post-operative recovery time.…”

Laparoscopic Surgery for Acute Diffuse Peritonitis Due to Gastrointestinal Perforation: A Nationwide Epidemiologic Study Using the National Clinical Database

“… 8 , 9 , 11 Diagnostic laparoscopy has been reported to be useful in the emergency setting because it can overcome the difficulty sometimes encountered in identification of the cause of acute abdomen by preoperative assessment using abdominal imaging methods such as ultrasound and computed tomography. 12 , 21 Patients with acute abdomen who cannot be diagnosed accurately often need exploratory surgery, which is invasive and may worsen their physical condition. An inappropriately positioned or wide skin incision may be harmful for patients.…”

“…Although laparoscopic surgery would not alter the outcome of acute diffuse peritonitis, its minimal invasiveness might aid the patient's ability to recover in the emergency setting if they are stable enough to tolerate it. 12 , 13 , 14 Acute diffuse peritonitis is a common critical disease, but the number of patients treated with the disease at a given institution is limited. Therefore, in this study we aimed to demonstrate trends in the use of the laparoscopy over time and compare the real‐world performance of laparoscopic surgery with that of open surgery in patients with acute diffuse peritonitis due to gastroduodenal or colorectal perforation using a nationwide surgical database in Japan.…”

Role of Laparoscopy in Management of Doubt Cases of Acute Abdomen

“…Diagnostic laparoscopy plays an important role in the evaluation of abdominal pain in young children. It has been studied and documented in many journals [4] .…”