Laparoscopic Approach to Acute Abdomen: A Multicenter Study

Abstract

Abdelmoneim Mohammed Ali Eljacki*

Background: Laparoscopy has become a routine procedure in managing acute abdominal disease and can be considered an excellent therapeutic and additional diagnostic tool in selected cases.

Objective: To identify the diagnostic and therapeutic value of laparoscopy in the management of acute abdomen in Khartoum state.

Methods: The study was a prospective, descriptive, cross-sectional hospital-based study. Conducted in Six centers around Khartoum state, in a period from October 2017 to October 2018. Patients whose laparoscopy was used for either diagnostic or therapeutic purposes in Acute abdomen were selected.

Results: The mean age was 29 ± 2.3 years. The duration of symptoms in 42 (70%) of the patients was 24-48 hours. The common three clinical diagnosis were acute cholecystitis 18 (30%), acute appendicitis 13 (21.7%) and uncertain diagnosis 11 (18.3%). The most common operative findings were pathology of the appendix 14 (23.3%) and gallbladder 14 (23.3%). Sensitivity, specificity, and accuracy of laparoscopy in the acute abdomen were 93.5%, 42.9%, and 81.8% respectively. Indicate good sensitivity specificity and high accuracy. The only reported immediate complication of the laparoscopic approach was bleeding in one patient. Unnecessary laparotomy was avoided in 10 cases (16.6%), 3 lap adhesiolysis, 4 cases of perforated duodenal ulcer,3 out of them found sealed, and in 1 case graham patch was done . 1 case of foreign body(pin) removal after trauma with pin gun, 1 case of ectopic pregnancy and I case of cholecystostomy tube. Diagnosis was confirmed in 11 (18.3%) of cases which were put in the category of uncertain diagnosis preoperatively.The reported late complications were port site infection 4 (6.7%), and incisional hernia 1 (1.7%). The duration of surgery was less than 2 hours in 38 (63.3%). 47 (78.3%) of the patients started oral feeding in less than 24 hours. Hospital stays in 48(80%) of the patients were 1-2 days.

Conclusion: The emergency laparoscopy for the acute abdomen is safe and accurate; these techniques reduce the rate of unnecessary laparotomy and avoid a delay in diagnosis.