Abstract
A laparoscopic approach is suggested with the highest grade of recommendation for acute cholecystitis, perforated gastroduodenal ulcers, acute appendicitis, gynaecological disorders, and non-specific abdominal pain (NSAP). To date, the main qualities of laparoscopy for these acute surgical scenarios are clearly stated: quicker surgery, faster recovery and shorter hospital stay. For the remaining surgical emergencies, as well as for abdominal trauma, the role of laparoscopy is still a matter of debate. Patients might benefit from a laparoscopic approach only if performed by experienced teams and surgeons which guarantee a high standard of care. More precisely, laparoscopy can limit damage to the tissue and could be effective for the reduction of the overall amount of cell debris, which is a result of the intensity with which the immune system reacts to the injury and the following symptomatology. In fact, these fragments act as damage-associated molecular patterns (DAMPs). DAMPs, as well as pathogen associated molecular patterns (PAMPs), are recognised by both surface and intracellular receptors of the immune cells and activate the cascade which, in critically ill surgical patients, is responsible for a deranged response. This may result in the development of progressive and multiple organ dysfunctions, manifesting with acute respiratory distress syndrome (ARDS), coagulopathy, liver dysfunction and renal failure. In conclusion, none of the emergency surgical scenarios preclude laparoscopy, provided that the surgical tactic could ensure sufficient cleaning of the abdomen in addition to resolving the initial tissue damage caused by the “trauma”.
Highlights
Why should laparoscopy be preferred in emergency?The history of laparoscopy in emergency and urgent surgical scenarios, both traumatic and pathological, began immediately after the implementation of the technique itself.Less than 20 years after the first experiment of laparoscopy on living dogs by Kelling in 1901 [1], the description concerning the use of laparoscopy for diagnosing traumatic hemoperitoneum appeared in the literature [2,3]
In the 1940s, laparoscopy was considered to be contraindicated for acute abdominal illnesses and stab wounds, gunshot wounds, and acute perforations of viscera, for fear of spreading infection [4], by this time it had already been accepted in its early stages as enabling a precise diagnosis [5]
The systematic review conducted by Lunevicius and Morkevicius revealed no statistically significant difference in the incidence of reintervention between the laparoscopic approach and the open technique, the incidence was doubled after laparoscopy (5.3% vs. 2.1%) [19]
Summary
The history of laparoscopy in emergency and urgent surgical scenarios, both traumatic and pathological, began immediately after the implementation of the technique itself. Laparoscopy Must Be the Preferred Approach in the Following Urgent Surgical Scenarios: Acute cholecystitis. In these scenarios, laparoscopy guarantees the main advantage of having a shorter hospital stay that is associated with a quicker surgery, which is that patients experience a faster and uneventful recovery. The main consequences are due to increased intra-abdominal pressure, which causes respiratory, cardiovascular, and neurological alterations. Absolute and relative contraindications to laparoscopy in the approach to abdominal emergencies are the same as for elective procedures; in general, stability of hemodynamic and respiratory parameters are required to perform laparoscopic procedures. The pneumoperitoneum could precipitate pre-existing abnormalities in cardiac output or gas exchange, as well as intracranial pressure, liver dysfunction or coagulopathy
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