Laparoscopic Surgery in Luminal Gastrointestinal Emergencies—a Review of Current Status

Abstract

Laparoscopy has already established itself as the preferred surgical approach in a variety of elective surgical conditions. Along with its usual advantages of less tissue trauma and faster recovery, its diagnostic as well as therapeutic role is making it an attractive option in emergency surgery. In this paper, we have reviewed the current status of laparoscopic surgery in luminal gastrointestinal emergencies. Relevant papers were selected using Medline database from 2007 to the present. These were reviewed, and outcomes were stated under the headings of appendicitis, perforated peptic ulcer, colorectal emergencies and small bowel obstruction. The laparoscopic intervention was found to be of clear benefit in most of the patients with appendicitis. Its role, however, is not absolutely clear in managing perforated peptic ulcers. Laparoscopic lavage and drainage have been recommended in diverticular perforation with limited contamination. Small case series and studies have shown benefits of laparoscopic surgery in iatrogenic colonic perforations, colonic obstruction, emergency colectomy and small bowel obstruction. Laparoscopic surgery can be recommended in appendicitis and lowrisk cases of perforated peptic ulcers. Its definitive role in other conditions needs more evidence. The surgeon's experience and careful patient selection are very important to improve the outcome.

Comparison of short-term therapeutic effects between laparoscopic surgery and laparotomy combined with new adjuvant radiochemotherapy in progressive stage-rectal carcinoma

“…Laparoscopic surgery can achieve long-term effect similar with that of laparotomy. It has advantages of minimally invasive, low occurrence rate of complications, quick recovery in a short period, and high clinical approval [9]. At present, few researches focus on the treatment of rectal carcinoma in the progressive stage by combining the new adjuvant radiochemotherapy as well as laparotomy and laparoscopic surgery.…”

The research progress of acute small bowel perforation

“…For the exploration of an acute abdomen, laparoscopy has been shown to be an important tool [10] . However, the surgeon has to decide in the acute situation whether laparoscopy is the proper method for the particular patient and for himself.…”

Comparative Analysis of Laparoscopic and Open Approaches in Emergency Abdominal Surgery

“…4 For some disease processes, there is clear evidence of benefit with a laparoscopic approach, for example, in acute appendicitis and acute cholecystitis. [4][5][6][7] However, the evidence is less clear for other abdominal surgical emergencies. [8][9][10] The benefits of a laparoscopic approach seen in elective surgeries, including reduced morbidity, postoperative pain, hospital length of stay (LOS), and time to resuming normal activities, likely also apply to appropriately selected emergency cases performed by surgeons with the necessary expertise.…”