Laparoscopy for management of nontraumatic acute abdomen

Navez, B.; d’Udekem, Yves; Cambier, Emmanuel; C, Richir; Pierpont, B. de; Guiot, Pierre

doi:10.1007/bf00299164

Cited by 60 publications

(40 citation statements)

References 14 publications

(16 reference statements)

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“…In selected patient populations where no prior diagnostic imaging has been performed, a diagnostic laparoscopy can accurately diagnose the cause of the abdominal pain in 80 - 94% of patients ((EL B) [33,34,35,36,37]). Postoperative complications have been reported in 3.5 - 25% of patients after diagnostic laparoscopy ((EL B) [33,34,36,37]) (online suppl. appendix 2, table 2.8).…”

Section: Resultsmentioning

confidence: 99%

Guideline for the Diagnostic Pathway in Patients with Acute Abdominal Pain

Gans

Pols²,

Stoker³

et al. 2015

Dig Surg

165

117

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Introduction: Diagnostic practice for acute abdominal pain at the Emergency Department varies widely and is mostly based on doctor's preferences. We aimed at developing an evidence-based guideline for the diagnostic pathway of patients with abdominal pain of non-traumatic origin. Methods: All available international literature on patients with acute abdominal pain was identified and graded according to their methodological quality by members of the multidisciplinary steering group. A guideline was synthetized, providing evidence-based recommendations together with considerations based on expertise of group members, patient preferences, costs, availability of facilities, and organizational aspects. Conclusions and Recommendations: Definition: Uniform terminology is needed in patients with acute abdominal pain to avoid difficulty in interpretation and ease comparison of findings between studies. We propose the use of the following definition for acute abdominal pain: pain of nontraumatic origin with a maximum duration of 5 days. Clinical diagnosis: Clinical evaluation is advised to differentiate between urgent and nonurgent causes. The diagnostic accuracy of clinical assessment is insufficient to identify the correct diagnosis but can discriminate between urgent and nonurgent causes. Patients suspected of nonurgent diagnoses can safely be reevaluated the next day. Based on current literature, no conclusions can be drawn on the differences in accuracy between residents and specialists. No conclusions can be drawn on the influence of a gynecological consultation. In patients suspected of an urgent condition, additional imaging is justified. CRP and WBC count alone are insufficient to discriminate urgent from nonurgent diagnoses. Diagnostic imaging: There is no place for conventional radiography in the work-up of patients with acute abdominal pain due to the lack of added value on top of clinical assessment. Computed tomography leads to the highest sensitivity and specificity in patients with acute abdominal pain. Positive predictive value of ultrasound is comparable with CT and therefore preferred as the first imaging modality due to the downsides of computed tomography; negative or inconclusive ultrasound is followed by CT. Based on current literature, no conclusions can be drawn on the added value of a diagnostic laparoscopy in the work-up of patients with acute abdominal pain. Antibiotic treatment should be started within the first hour after recognition of sepsis. Administration of opioids (analgesics) decreases the intensity of the pain and does not affect the accuracy of physical examination.

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Section: Resultsmentioning

confidence: 99%

Guideline for the Diagnostic Pathway in Patients with Acute Abdominal Pain

Gans

Pols²,

Stoker³

et al. 2015

Dig Surg

165

117

View full text Add to dashboard Cite

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“…Many studies have demonstrated a high diagnostic accuracy for DL (70-99%; levels 1-3 evidence) [2][3][4][5][6][7][8][9][10][11][12][13][14]. A randomized trial for acute nonspecific abdominal pain by Decadt et al [2] showed that the application of early DL significantly improved diagnostic accuracy compared with an observation group (81% vs 36%; p\0.001).…”

mentioning

confidence: 97%

“…Findings have shown that DL changes the treatment strategy for 10% to 58% of patients with acute nonspecific abdominal pain (levels 2 and 3 evidence) [4][5][6][7][8][9][10]. Although computed tomography (CT) of the abdomen and pelvis was scarcely used during the preoperative workup in the majority of published studies reviewed, one study demonstrated a higher diagnostic accuracy with DL in the diagnosis of diverticulitis than with CT of the abdomen or colonic contrast enema (level 2 evidence) [14].…”

mentioning

confidence: 99%

The role of diagnostic laparoscopy for acute abdominal conditions: an evidence-based review

et al. 2008

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Diagnostic laparoscopy is minimally invasive surgery for the diagnosis of intraabdominal diseases. This study aim was a critical examination of the available literature on the role of laparoscopy for the diagnosis and treatment of acute intraabdominal conditions. A systematic literature search of English-language articles on MEDLINE, the Cochrane database of evidence-based reviews, and the Database of Abstracts of Reviews of Effects was performed for the period 1995-2006. The level of evidence in the identified articles was graded. This review examines the role of diagnostic laparoscopy for acute nonspecific abdominal pain, trauma, and the acute abdomen experienced by the critically ill patient. The indications, contraindications, risks, benefits, diagnostic accuracy of the procedure, and associated morbidity are discussed. The limitations of the available literature are highlighted, and evidence-based recommendations for the use of diagnostic laparoscopy to determine acute intraabdominal conditions are provided.

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“…Although a number of studies [1,4,14] have described laparoscopic surgery used in nontrauma emergencies other than acute cholecystitis, it is clear that more experience and collective data are needed.…”

mentioning

confidence: 99%