Published online Jan 14, 2016. doi: 10.3748/wjg.v22.i2.668
Peer-review started: May 7, 2015
First decision: July 21, 2015
Revised: September 10, 2015
Accepted: November 19, 2015
Article in press: November 19, 2015
Published online: January 14, 2016
The greatest advantages of laparoscopy when compared to open surgery include the faster recovery times, shorter hospital stays, decreased postoperative pain, earlier return to work and resumption of normal daily activity as well as cosmetic benefits. Laparoscopy today is considered the gold standard of care in the treatment of cholecystitis and appendicitis worldwide. Laparoscopy has even been adopted in colorectal surgery with good results. The technological improvements in this surgical field along with the development of modern techniques and the acquisition of specific laparoscopic skills have allowed for its utilization in operations with fully intracorporeal anastomoses. Further progress in laparoscopy has included single-incision laparoscopic surgery and natural orifice trans-luminal endoscopic surgery. Nevertheless, laparoscopy for emergency surgery is still considered challenging and is usually not recommended due to the lack of adequate experience in this area. The technical difficulties of operating in the presence of diffuse peritonitis or large purulent collections and diffuse adhesions are also given as reasons. However, the potential advantages of laparoscopy, both in terms of diagnosis and therapy, are clear. Major advantages may be observed in cases with diffuse peritonitis secondary to perforated peptic ulcers, for example, where laparoscopy allows the confirmation of the diagnosis, the identification of the position of the ulcer and a laparoscopic repair with effective peritoneal washout. Laparoscopy has also revolutionized the approach to complicated diverticulitis even when intestinal perforation is present. Many other emergency conditions can be effectively managed laparoscopically, including trauma in select hemodynamically-stable patients. We have therefore reviewed the most recent scientific literature on advances in laparoscopy for acute care surgery and trauma in order to demonstrate the current indications and outcomes associated with a laparoscopic approach to the treatment of the most common emergency surgical conditions.
Core tip: Although laparoscopy today represents the undisputed standard of care for the treatment of acute cholecystitis and appendicitis worldwide, laparoscopy for emergency surgery is still considered challenging and not recommended due to the lack of adequate experience and/or appropriate laparoscopic skills. However, the potential advantages of laparoscopy, both in terms of diagnosis and therapy, are clear. Like complicated appendicitis and cholecystitis, major advantages may be observed in cases with diffuse peritonitis secondary to perforated peptic ulcers, acute diverticulitis and many other often traumatic emergency conditions.