Non-traumatic Abdominal Emergencies Research Articles

Should an appendicectomy be performed in the presence of a macroscopically healthy appendix, during laparoscopic exploration?

Introduction: In contrast to the conventional laparotomy approach, the decision to perform an appendicectomy or not in the presence of a macroscopically normal appendix remains contentious during laparoscopic procedures. Our objective is to assess the rate of appendix conservation and conduct a literature review on the management of a macroscopically normal appendix intraoperatively. Materials and Methods: This was a descriptive, prospective, evaluative study involving 337 patients undergoing laparoscopic surgery for non-traumatic acute abdominal emergencies. Results: Of the 337 patients operated on, 190 were females (56.4%), with a mean age of 38 years ± 15 years (range 15 to 82 years). In 7 patients (2.1%), the appendix appeared macroscopically normal intraoperatively, despite preoperative diagnosis favoring acute appendicitis. These 7 patients (6 females and 1 male) all underwent thorough clinical examination and preoperative ultrasound, although CT scans were performed in only 3 patients. Among these 7 patients, 2 had ovarian cyst torsions, 2 had ruptured hemorrhagic ovarian cysts, 1 case was diagnosed as retrocaecal internal hernia, and in 2 patients, no etiology was identified. The appendix was preserved in all 7 cases. All patients received postoperative antibiotic therapy. No postoperative complications or surgical reinterventions were recorded. Conclusion: Our study demonstrates that a macroscopically normal appendix can be left in situ without postoperative complications or need for surgical reintervention.

Abdominal emergency laparoscopy: Addressing anesthetic concerns for abdominal emergency surgery

Introduction: CO2 insufflation during laparoscopic procedures leads to respiratory changes, making general anesthesia during laparoscopy considered high-risk anesthesia. In an emergency context, this risk is likely heightened. The objective of our study is to evaluate the role of anesthesia during laparoscopy in non-traumatic emergency abdominal surgery. Materials and Methods: Descriptive and prospective study conducted between February 2018 and October 2021, involving 337 patients undergoing laparoscopic surgery for non-traumatic acute abdominal emergencies. Results: Of the 337 patients operated on, 190 were female (56.4%) and 147 were male (43.6%), with a mean age of 38 years ± 15 years (range 15-82 years). Comorbidities were noted in 109 patients (32.3%), with 39 patients (11.6%) having multiple concomitant comorbidities. Our patients were classified as ASA I in 74.8% (252 patients), ASA II in 22% (74 patients), and ASA III in 3.3% (11 patients). Perioperative morbidity and mortality related to anesthesia were nil. During the analytical study, we found no correlation between anesthesia duration and perioperative and postoperative morbidity and mortality (p value: 0.082) and no relationship between ASA stage and postoperative morbidity (p value = 0.392, chi-square test). Conclusion: Emergency abdominal surgery via laparoscopy is feasible and safe from an anesthetic standpoint.

Is night emergency laparoscopy a high-risk surgery?

Introduction: Although laparoscopy has become the gold standard for many abdominal emergency pathologies, emergency nighttime laparoscopic surgery is considered high-risk for several reasons, particularly due to limited resources in the operating room during nighttime hours. The primary objective of our study is to evaluate the feasibility and safety of nighttime laparoscopy in the management of non-traumatic acute abdomen. Materials and Methods: Descriptive and prospective, evaluative study conducted between February 2018 and October 2021. Our study included 337 patients undergoing laparoscopic surgery for non-traumatic acute abdominal emergencies. Results: Among the 337 patients, we operated on 211 patients (62.6%) outside of regular working hours (between 4:00 PM and 8:00 AM), of which 189 patients (56.10%) were operated on from 4:00 PM to 12:00 AM, and 22 patients (6.2%) from 12:00 AM to 8:00 AM. The mean operative time was 52.09 ± 24.14 minutes. Perioperative difficulties related to the operated pathology were encountered in 21 cases (9.95%). The overall mean hospital stay was 1 day (range: 7 hours - 4 days). We compared nighttime laparoscopy with daytime laparoscopy and found an advantage in favor of nighttime laparoscopy in reducing hospitalization duration (p value 0.003). Conclusion: Nighttime laparoscopy is feasible and safe.

Emergency laparoscopic surgery in pregnancy

Introduction: The decision to proceed with surgical intervention is often difficult in pregnant women, particularly in emergency contexts. Opting for laparoscopic surgery in pregnant women is even more challenging. Concerns during laparoscopic procedures include potential fetal injury, reduced uterine blood flow due to pneumoperitoneum, and fetal acidosis. The objective of our study is to evaluate the feasibility and morbidity-mortality of emergency laparoscopy in pregnant women. Materials and Methods: This is a descriptive and prospective study conducted between February 2018 and October 2021, involving 337 patients who underwent laparoscopic surgery for acute non-traumatic abdominal emergencies. Results: Among the 190 female patients operated on, 18 patients (9.47%) were pregnant: 8 (44.5%) had acute appendicitis, 7 (38.9%) had acute lithiasic cholecystitis, 2 (11.2%) had ovarian cyst torsion, and 1 (5.6%) had an appendiceal abscess. This laparoscopic management was performed across different gestational ages. The mean gestational age of our patients was 15 ± 14 weeks of amenorrhea (minimum 7 weeks, maximum 29 weeks). The mean operative time for the surgical interventions in these pregnant women was 61.2 minutes ± 20.16 minutes. No intraoperative complications or incidents, no conversions, and no abortions were recorded. Conclusion: Laparoscopy can be safely used to manage acute non-traumatic abdominal emergencies during pregnancy.

The impact of laparoscopic surgery on postoperative pain: A prospective study

Introduction: The reduction of postoperative pain intensity is recognized as one of the major advantages of laparoscopic surgery. However, even though this pain is of low intensity, it is not completely abolished after laparoscopic surgery, and may even be multifactorial in origin. The objective of our study is to evaluate pain after laparoscopic surgery and to highlight the various causes of pain. Materials and Methods: This is a descriptive and prospective study involving 337 patients undergoing laparoscopic surgery for non-traumatic acute abdominal emergencies between February 2018 and October 2021. Pain was assessed using the visual analog scale (VAS). Results: Postoperative pain was present in 335 patients (99.4%) on postoperative day 0 and in 283 patients (83.98%) on postoperative day 1. This pain was of low intensity in the majority of cases (73%, n=246 patients) on postoperative day 0 and (68.5%, n=231 patients) on postoperative day 1. Surgical site pain was present in 134 cases (39.77%), pain related to delayed intestinal transit in 52 cases (15.43%), shoulder pain related to CO2 in 40 cases (11.87%), and a combination of different types of pain was found in 16.7% of patients. Conclusion: Post-laparoscopic surgery pain is multifactorial, of low intensity, and easily managed with first-tier analgesics.

Feasibility and safety of laparoscopy in acute non-traumatic emergency abdominal surgery: A prospective study

Introduction: The use of laparoscopy in emergency abdominal surgery is considered high-risk due to its elevated morbidity, requiring expertise in laparoscopic surgery. Objective: Assessing the feasibility, reproducibility, and safety of laparoscopy in non-traumatic acute abdominal surgery. Methods: Descriptive, prospective and evaluative study, conducted between February 2018 and October 2021. We have included in this study: acute appendicitis and its complications, lithiasis acute cholecystitis (LAC), peritonitis by perforation of peptic ulcer, adhesive acute intestinal obstruction, adnexal torsion, extra-uterine pregnancies, and non-specific acute abdominal pain. Results: We operated on 337 patients laparoscopically, with an average of 02 surgeries per medical shift. In 62.6%, surgeries were performed outside of regular working hours. We encountered temporary, material, and human difficulties in 10.8% of the cases. Average age of the patients is 38 years ±15 years. F/H sex ratio =1.29. Diagnostic accuracy of laparoscopy was 100 %. Intraoperative laparoscopic scanning corrected the preoperative diagnosis in 15.73% of cases. Average operative time was 52.09 min ± 24.14 min. One conversion recorded (0.3%). Rate of postoperative complications was 6.2%. These complications are classified at grade I according to the Clavien-Dindo classification in 85.71%. Only one patient (0.3%) required a second operation. Average length of overall hospitalization was 1.5 days. Conclusion: Our results suggest that emergency laparoscopy is feasible, safe, and reproducible. So it can claim to replace laparotomy in the management of acute, non-traumatic abdominal emergencies.

Study of Risk Factors for Morbidity in Emergency Abdominal Laparoscopy Surgery

Introduction: Emergency laparoscopy is regarded as a challenging and high-risk domain due to the requisite expertise in both laparoscopic and emergency surgery. Additionally, the physical fatigue of surgical teams and the urgency context contribute to potential increased morbidity rates in emergency surgery. Furthermore, a primary concern with laparoscopy is the frequency of deep collections. The objective of our study was to evaluate the risk factors for morbi-mortality associated with laparoscopic intervention in non-traumatic acute abdominal emergencies. Materials and Methods: A descriptive, prospective, evaluative study was conducted between February 2018 and October 2021, encompassing 337 patients undergoing laparoscopic surgery for non-traumatic acute abdominal emergencies. Results: Among the 337 operated patients, perioperative morbidity was 0.3%, and postoperative morbidity was 6.2% (21 patients). These postoperative complications were classified as grade I in 85.71% of cases (18 patients). The mean age of the patients was 38 years ± 15 years. Body mass index (BMI) was above 25 in 179 patients (53.11%). The mean operative time across all pathologies was 52.09 minutes ± 24.14 minutes (Range: 14-178 minutes). The average overall hospitalization duration was 1.5 days (Range: 1 to 8.5 days).The only factor correlated with the occurrence of postoperative complications was obesity (p=0.003). Conclusion: Emergency laparoscopy does not exacerbate morbidity and can be safely performed for the management of acute abdominal emergencies.

Impact of anterior component separation technique on lowering the incidence of abdominal wall dehiscence and incisional hernia after emergent laparotomy: a feasibility study

Introduction Abdominal wall dehiscence is one of the critical postoperative complications following abdominal surgeries. Emergency surgery highly contributes to the incidence of a burst abdomen due to a lack of proper preoperative preparation and the presence of intraabdominal sepsis. Anterior component separation was primarily evolved in abdominal wall reconstruction in the open abdomen and huge ventral hernia repair. Methods This prospective study included 50 patients operated by midline laparotomy for non-traumatic abdominal emergencies. Anterior component separation technique was randomly applied in 25 patients before laparotomy closure, the other 25 patients were closed using the traditional midline closure method. Preoperative patient’s demographics, operative time, and different postoperative complications were reported. Incidence of burst abdomen in both groups was reported. Results Preoperative patient’s demographic data showed no significant difference between both groups; the mean age of the patients was 53.69±7.34. Operative time was significantly longer in the Anterior Components Separation (ACS) group (P<0.001). The incidence of abdominal wall dehiscence after ACS technique (4.3%) was significantly less than after traditional technique (24%). Postoperative seroma and hematoma were the common postoperative complications after ACS however the incidence was not statistically significant. Incisional hernia was detected in (13.04%) in ACS group and in (32%) in traditional group. Conclusion Application of ACS technique during laparotomy closure in abdominal emergencies seems to lower the incidence of abdominal wall dehiscence with no increase in different postoperative complications.

Non-traumatic abdominal surgical emergencies in children in Dapaong (TOGO)

IntroductionSurgical abdominal emergencies in children are responsible for high morbidity and mortality. They are numerous and their management in Africa is difficult. The management of non-traumatic abdominal emergencies in children in a regional hospital in Togo is described. Methodand study setting: This was a single-center, retrospective and descriptive study conducted over a 12-month period. It included all children aged 0–15 years treated at the hospital for non-traumatic abdominal surgical emergencies. ResultsWe reported 217 cases of non-traumatic abdominal surgical emergencies in children. We noted a male predominance with a sex ratio of 1.57. Similarly, grandchildren were predominant (44.70 %). A low school attendance rate was noted (21.20 %) and the children were mostly from poor families (32.72 %). The average consultation time was 5.3 ± 1.03 days. Pain was the main symptom and was present in all children. An unprepared abdominal X-ray was the main imaging procedure performed (77.18 %). These conditions were dominated by peritonitis (56.68 %). These were mainly ileal perforations. All the children received surgical treatment. The postoperative course was marked by complications in 104 children (47,93 %) and 14 deaths (6,45 %). ConclusionNon-traumatic abdominal surgical emergencies in children are dominated by peritonitis in rural Togo. They could be related to poverty. An effective policy of universal access to health care is essential.

Non-Traumatic Abdominal Surgical Emergencies in the Field of HIV: A Series of 22 Cases in the Visceral and Digestive Surgery Department of the Siguiri Prefectural Hospital

Introduction: This study aimed to describe the epidemiological-clinical and therapeutic aspects of abdominal surgical emergencies on the ground of HIV in the department of visceral and digestive surgery of the prefectural hospital of Siguiri. Method: This was a descriptive prospective study which concerned patients operated on for abdominal surgical emergencies in the field of HIV, carried out in the visceral and digestive surgery department of the Siguiri prefectural hospital. Results: Out of a total of 88 cases of abdominal surgical emergencies operated on during our study, we collected 22 cases on HIV ground, i.e. 25%. The female sex dominated, including 14 women against 8 men, i.e. a sex ratio of 0.6 with an average age of 35 years. Miners were the most affected socio-professional layer, i.e. 31.80%, followed by traders and housewives, i.e. 27.30% each. HIV type I affected 77.27% against 22.73%. There were 41% of our patients who knew their serological status among which 66.66% were on ARV treatment and 33.33% were not on ARV treatment. The symptomatology was dominated by abdominal pain in 100% followed by fever in 77.27%. Appendicitis accounted for 40.09% followed by generalized acute peritonitis in 31.82%. The management was medico-surgical with pre-operative, intra-operative and post-operative resuscitation. The average length of hospitalization was 7 days. The postoperative course was favorable in 45.45%, we recorded 36.36% parietal suppuration and the mortality rate was 13.64%. Conclusion: Abdominal surgical emergencies in the field of HIV remain a major health problem in terms of care. The clinical pictures are dominated by acute appendicitis and generalized acute peritonitis.

Management of Abdominal Surgical Emergencies at the General Reference Hospital, What Place for Laparoscopic Surgery?

Aim of the study: The purpose of this article is to report the experience of the General Reference Hospital in the surgical management of abdominal emergencies. Patients and Methods: This was a prospective study over 3 years 5 months (08/12/2017 to 31/05/2021) which concerned patients operated for an abdominal emergency at the General Reference Hospital of Niamey. Results: We had 170 patients operated for an abdominal emergency (8.37%), with a male predominance (61.50%) and a sex ratio of 1.59. The average age was 36.08 years with a standard deviation of 17.46 and extremes of 2 to 79 years. Non-traumatic abdominal emergencies dominated with 96.47%. Abdominal ultrasound was performed in 92.35% (n=157) of patients and abdominal CT scan in 35.88% (n=61). General anesthesia was performed in 97.06% of cases (n=165). The approaches were laparotomy in 72.35% (n=123) and laparoscopy in 27.65% (n=47). The most reported intraoperative diagnoses were acute appendicitis 40.59% (n=69) followed by acute peritonitis 18.82% (n= 32) and acute cholecystitis 13,53% (n= 23). The main procedures performed by laparoscopy were appendectomies, cholecystectomies and acute peritonitis in respectively 15.29%, 10.59% and 1.76% of cases. Postoperative complications represented 2.35% (n=4) in laparoscopy and 9.41% (n=16) in laparotomy. Conclusion: Abdominal emergencies at the Reference General Hospital are frequent and postoperative complications are few especially at laparoscopy, which is a first way to encourage in our context; It gives better surgical outcomes than conventional surgery.

CT in non-traumatic acute abdominal emergencies: Comparison of unenhanced acquisitions and single-energy iodine mapping for the characterization of bowel wall enhancement

To evaluate the benefit of unenhanced CT and single energy iodine mapping (SIM) to conventional contrast-enhanced CT for bowel wall enhancement characterization in an acute abdomen setting. CT images from 45 patients with a suspected acute abdomen who underwent abdominopelvic CT from April 2018 to June 2018 were analyzed retrospectively by two independent radiologists. These patients had been referred by emergency department physicians in a context of acute abdominal pain and had a confirmed etiological diagnosis. Three image sets were evaluated separately (portal phase images alone; portal phase images and unenhanced images, portal phase images, and single energy iodine maps). Diagnostic accuracy and confidence were assessed. Quantitative analysis of bowel wall enhancement was also performed. The number of correct diagnoses increased by 8% and 12% with unenhanced images and 6% and 13% with SIM for readers 1 and 2, respectively, compared to the portal phase only. There was an improvement in the confidence of the etiological diagnosis with the number of certain diagnoses increasing from 23% to 100%, which was statistically significant for reader 2 and of borderline significance for reader 1 (P = 0.002 and 0.052, respectively) when unenhanced phase and SIM were added. The inter-rater agreement improved when unenhanced and portal phase images were associated, compared to portal phase images alone (kappa = 0.652 [ICC=0.482–0.822] and 0.42 [ICC=0.241–0.607] respectively). SIM and unenhanced images improve the reproducibility and the diagnostic confidence to diagnose ischemic and inflammatory/infectious bowel wall thickening compared to portal phase images alone The analysis of unenhanced and SIM images in association with portal phase images improves the reproducibility and the radiologist's confidence in the etiological diagnosis of acute non-traumatic bowel wall thickening in adults.

The “Black Pattern”, a Simplified Ultrasound Approach to Non-Traumatic Abdominal Emergencies

Background: A key issue in abdominal US is the assessment of fluid, which is usually anechoic, thus appearing “black”. Our approach focuses on searching for fluid in non-traumatic patients, providing a new, simplified method for point-of-care US (POCUS). Objective: Fluid assessment is based on a three-step analysis that we can thus summarize. 1. Look for black where it should not be. This means searching for effusions or collections. 2. Check if black is too much. This means evaluating anatomical landmarks where fluid should normally be present but may be abnormally abundant. 3. Look for black that is not clearly black. This means evaluating fluid aspects, whether wholly anechoic or not (suggesting heterogeneous or corpusculated fluid). Discussion: Using this simple method focused on US fluid presence and appearance should help clinicians to make a timely diagnosis. Although our simplified, systematic algorithm of POCUS may identify abnormalities; this usually entails a second-level imaging. An accurate knowledge of the physio–pathological and anatomical ultrasound bases remains essential in applying this algorithm. Conclusion: The black pattern approach in non -traumatic emergencies may be applied to a broad spectrum of abnormalities. It may represent a valuable aid for emergency physicians, especially if inexperienced, involved in a variety of non-traumatic scenarios. It may also be a simple and effective teaching aid for US beginners.

Clinical Profile of Non-Traumatic Surgical Abdominal Emergencies in a Tertiary Care Centre in Eastern Part of India

Aim: (a) To study the clinical profile, demographics, symptoms, and indicators of patients with abdominal emergencies requiring non-traumatic surgery. (b) To determine the diagnosis and the appropriate treatment options for patients presenting to the emergency room with abdominal surgical crisis that are not trauma related. (c) To examine the results of various treatment approaches in patients who have non-traumatic surgical abdominal emergencies and present to the emergency room. Methods: The study included all non-trauma patients under 70 years of age who presented to emergency with abdominal pain. Results: In our analysis, acute appendicitis was the most frequent cause of acute abdomen, followed by acute intestinal blockage, cholecystitis, and nephrolithiasis. Conclusion: During the workup of these patients, clinicians must take several diagnoses into account; those individuals who may need surgical exploration should be recognised early to reduce their morbidity and death.

Damage-control surgery in patients with nontraumatic abdominal emergencies: A systematic review and meta-analysis.

After the successful implementation in trauma, damage-control surgery (DCS) is being increasingly used in patients with nontraumatic emergencies. However, the role of DCS in the nontrauma setting is not well defined. The aim of this study was to investigate the effect of DCS on mortality in patients with nontraumatic abdominal emergencies. Systematic literature search was done using PubMed. Original articles addressing nontrauma DCS were included. Two meta-analyses were performed, comparing (1) mortality in patients undergoing nontrauma DCS versus conventional surgery (CS) and (2) the observed versus expected mortality rate in the DCS group. Expected mortality was derived from Acute Physiology And Chronic Health Evaluation, Simplified Acute Physiology Score, and Portsmouth Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity scores. A total of five nonrandomized prospective and 16 retrospective studies were included. Nontrauma DCS was performed in 1,238 and nontrauma CS in 936 patients. Frequent indications for surgery in the DCS group were (weighted proportions) hollow viscus perforation (28.5%), mesenteric ischemia (26.5%), anastomotic leak and postoperative peritonitis (19.6%), nontraumatic hemorrhage (18.4%), abdominal compartment syndrome (17.8%), bowel obstruction (15.5%), and pancreatitis (12.9%). In meta-analysis 1, including eight studies, mortality was not significantly different between the nontrauma DCS and CS group (risk difference, 0.09; 95% confidence interval, -0.06 to 0.24). Meta-analysis 2, including 14 studies, revealed a significantly lower observed than expected mortality rate in patients undergoing nontrauma DCS (risk difference, -0.18; 95% confidence interval, -0.29 to -0.06). This meta-analysis revealed no significantly different mortality in patients undergoing nontrauma DCS versus CS. However, observed mortality was significantly lower than the expected mortality rate in the DCS group, suggesting a benefit of the DCS approach. Based on these two findings, the effect of DCS on mortality in patients with nontraumatic abdominal emergencies remains unclear. Further prospective investigation into this topic is warranted. Systematic review and meta-analysis, level III.

The treatment of acute appendicitis in two age-based groups during COVID-19 pandemic: a retrospective experience in a COVID-19 referral hospital.

PurposeDuring the past months, the Italian Government has reduced the restrictions and access to hospitals as well as outpatient. Since then, up to 40% of non-traumatic abdominal emergencies have had unusual delayed treatment. Given the rapidly evolving situation and the absence of evidence to support recommendations during the COVID-19 pandemic, it is useful to assess how the current situation is influencing the management of elderly patients with acute appendicitis.MethodsBetween February 2020 and December 2020, all patients 18 years or older undergone appendectomy were included. Patients were divided in two age-based groups (young groups, YG; elderly group, EG). Surgical approach, hospital stay, post-operative complications, radiology reports, and histologic examination were included in the retrospective analysis.ResultsOne hundred eight patients underwent appendectomy, 81 patients into the YG, and 27 in the EG. Laparoscopy was performed in 87.7% of the YG and in 51.8% of the elderly (p < 0.000), while conversion to laparotomy was necessary in 3.7% in the YG vs 22.3% of the other group (p < 0.009). Open procedures were more frequent in the EG, 25.9% vs 8.6% (p value < 0.05). No mortality rate was reported in both groups; moreover, the mean hospital stay was greater in the EG than the YG (p < 0.000).ConclusionOur data highlighted a partial delay in diagnosis in the elderly group, and an increase in complicated appendicitis also demonstrated by the need for conversion to laparotomy despite no significant relationship between these findings and the histologic examination was reported.

Non-traumatic abdominal surgical emergencies at the Communal Medical Center (CMC) of Matam, Conakry

Aim: The aim of the study was to bring the frequency and management of non-traumatic abdominal surgical emergencies back to the Matam communal medical center. Material and methods: This was a retrospective, descriptive three-year study (January 2016 to December 2018) which focused on the files of patients treated in the surgical department of the surgical medical center (CMC). By Matam, for a non-traumatic abdominal surgical emergency. Results: Non-traumatic abdominal surgical emergencies represented 49.98% compared to surgical pathologies. The average age was 31.36% with extremes of 10 and 75 years. A male predominance was noted with a sex ratio = 1.07. The average consultation time was 5.53 days. Abdominal pain was the main reason for consultation. Acute appendicitis and strangulated hernias were the most common and ultrasound was performed in 21 patients (5.05%) and unprepared abdominal x-ray was performed in 49 patients (11.89%). All cases were operated on urgently. The operative consequences were simple in 94.42%. We noted parietal suppurations in 2.18%, postoperative peritonitis in 2.43% of cases and 9 deaths. The mean hospital stay was 7.14 days. Conclusion: non-traumatic abdominal emergencies constitute a public health problem, the prognosis depends on the quality and the precocity of the patient's care.

Non-traumatic abdominal surgical emergencies at the Communal Medical Center (CMC) of Matam, Conakry

Non-traumatic abdominal surgical emergencies at the Communal Medical Center (CMC) of Matam, Conakry

The Emergency Hospital Bucharest to the Forefront of the Emergency Laparoscopic Surgery Development

The use of laparoscopy in traumatic and non-traumatic abdominal surgical emergencies is unanimously accepted due to the well-known advantages of minimally invasive surgery. In the period 1961-1966 in the Clinical Emergency Hospital of Bucharest (CEHB) the first diagnostic laparoscopes were performed in the acute surgical abdomen, respectively in the obstructive jaundice by dr. Gh.Popovici, respectively dr.C.Petrescu.In the modern era, the first laparoscopic cholecystectomy was performed in 4 dec. 1993 by A.E.N.In 1994 the first laparoscopic appendectomies, gynecological emergencies, exploration in traumatic abdominal contusion, followed by perforated ulcer (1995), intestinal occlusion (1997), were performed. In the specialized literature, out of the 42 emergency laparoscopy articles published in the journal “Chirurgia” (1994-2019), 16 (38,08%) belonged to the CEHB team, 11 of AEN. In 2004 the original monograph "Laparoscopic Emergency Surgery" appeared. Specialized chapters are added in different volumes of surgical pathology. At the Romanian Assocation of Endoscopic Surgery Congress (RAES) of 2008, the international participation course “Laparoscopy in the acute abdomen” was organized. Since 2013, annual trauma workshops (DSTC ™) and non-traumatic abdominal emergencies have been organized with international participation by CEHB, the surgery clinic, and the UMFCarol Davila Department of Anatomy. CEHB surgeons presented papers at EAES,EATES and ESTES congresses. Of the 1699 laparoscopic operations performed in the clinic in 2018, accounting for 31.27% of the total operations, 493 (29.01%) were in emergency. The SCUB surgeons have had and have a major contribution in preparing the residents, implementing and developing emergency laparoscopy within the miniminvasive therapy, the therapy of the future.

Damage-control surgery in patients with non-traumatic abdominal emergencies: A meta-analysis

Abstract Objective After the successful implementation in trauma patients, damage control surgery (DCS) is being increasingly used in non-traumatic abdominal emergencies, too. However, non-trauma DCS (NT-DCS) is currently a matter of debate and has not yet been comprehensively assessed. The aim of this meta-analysis was to investigate the effect of NT-DCS on mortality in patients with abdominal emergencies. Methods Systematic literature search using PubMed. Original articles addressing mortality in patients undergoing NT-DCS or non-trauma conventional surgery (NT-CS) for abdominal emergencies were included. Descriptive statistics and two meta-analyses were performed. Meta-analysis 1 compared mortality in patients undergoing NT-DCS vs. NT-CS. Meta-analysis 2 assessed the observed vs. expected mortality rate, based on APACHE, POSSUM and SAPS scores, in the NT-DCS group. Continuous and categorical variables were reported as weighted means and proportions. Effect sizes were described as risk differences (RD) with 95% confidence intervals (CI). Results Literature search revealed 1314 articles. Of these, 21 studies published 2004-2019 were included. NT-DCS was performed in 1238 and NT-CS in 936 patients. In the NT-DCS vs. NT-CS group mean age was 61.0 vs. 64.9 years and the proportion of male patients 58.6% vs. 52.9%, respectively. Most frequent indications for NT-DCS were hollow viscus perforation (28.4%), mesenteric ischemia (26.5%), anastomotic leak (19.6%), haemorrhage (18.4%), abdominal compartment syndrome (17.4%), bowel obstruction (15.5%), and pancreatitis (13.1%). In meta-analysis 1, mortality was not significantly different in the NT-DCS vs. NT-CS group (RD 0.09, 95% CI -0.06/0.24). Meta-analysis 2 revealed a significantly lower observed than the expected mortality rate in patients undergoing NT-DCS (RD -0.18, 95 % CI -0.29/-0.06). Heterogeneity of included studies was high in both meta-analyses (I2=89.0% and 79.9%, respectively). Conclusion This meta-analysis revealed no significantly different mortality in patients with abdominal emergencies undergoing NT-DCS vs. NT-CS. However, observed mortality was significantly lower than the expected mortality rate in the NT-DCS group, suggesting a benefit of the DCS approach. Based on these results, the effect of DCS in patients with non-traumatic abdominal emergencies remains unclear. Further prospective investigation into this topic is warranted.