The laparoscopy in emergency general surgery (LEGS) study: a questionnaire survey of UK practice

Abstract

Introduction Recent consensus guidelines suggest that the laparoscopic approach may be a useful, safe and feasible approach in emergency general surgery. Despite this, the UK National Emergency Laparotomy Audit (NELA) suggests the rate of laparoscopy is low (9% fully laparoscopic) and slow to increase over time. A European survey found uptake to be variable. This UK survey was therefore undertaken to establish current UK practice and to determine factors affecting implementation. Materials and methods A questionnaire survey of currently practising UK consultant general surgeons was carried out by the North West Surgical Research Collaborative, using a secure web-based database maintained by the North West Surgical Trials Centre. Results A total of 151 completed questionnaires were returned from 22 UK centres; 18% of respondents were unaware that laparoscopic cases should be reported to NELA. Appendicectomy (97%) and cholecystectomy (87%) were routinely performed laparoscopically. Laparoscopy was infrequently used in perforation, ischaemia or obstructed hernias. There appears to be equipoise regarding laparoscopic compared with open surgery in small-bowel obstruction among all subspecialty emergency general surgeons, in perforated peptic ulcer among upper gastrointestinal surgeons and in Hinchey III diverticulitis among colorectal surgeons. Conclusion Uptake of laparoscopy in UK emergency general surgery is influenced by surgeon preference, subspecialty, patient and operative factors. Further research into outcomes may help to identify areas of greatest potential benefit. The rate of laparoscopy reported by NELA may be an underestimate due to the 18% of surgeons unaware that laparoscopic cases should be reported, which may affect the validity of analyses performed from this dataset.

Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS®) Society Recommendations Part 2—Emergency Laparotomy: Intra‐ and Postoperative Care

“…The use of initial diagnostic laparoscopy has increased during the past decade due to increased experience and training [ 28 ]. An initial diagnostic laparoscopy can always be converted to an open laparotomy technique.…”

Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach

“…The surgeons’ greater experience in laparoscopic surgery and the remarkable development of various laparoscopic surgical equipment and new anaesthesiology techniques had led to the improvement of the safety and feasibility of laparoscopic procedures. As a consequence, a large diffusion of minimally invasive approaches for the execution of more complex and demanding operations has been seen also in the emergency setting [ 18 , 29 , 30 ]. The surgical approach to perforated peptic ulcer has changed dramatically in recent decades.…”

Comparison of Omental Patch Closure Versus Simple Closure for Laparoscopic Repair of Perforated Peptic Ulcer: A Systematic Review and Meta-Analysis

“…Certainly, in the UK in the emergency setting, rates of laparoscopic surgery compared with an open approach are slow to increase. 52 As such, a small sample size may be inadequate to detect small differences between omental patch repair and repairs without an omental patch.…”