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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2016; 22(2): 668-680
Published online Jan 14, 2016. doi: 10.3748/wjg.v22.i2.668
Advances in laparoscopy for acute care surgery and trauma
Matteo Mandrioli, Kenji Inaba, Alice Piccinini, Andrea Biscardi, Massimo Sartelli, Ferdinando Agresta, Fausto Catena, Roberto Cirocchi, Elio Jovine, Gregorio Tugnoli, Salomone Di Saverio
Matteo Mandrioli, Alice Piccinini, Andrea Biscardi, Elio Jovine, Gregorio Tugnoli, Salomone Di Saverio, Department of Emergency and General Surgery and Trauma Surgery Unit, C. A. Pizzardi Maggiore Hospital Trauma Center, 40133 Bologna, Italy
Kenji Inaba, Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, CA 90033, United States
Massimo Sartelli, Department of Surgery, Macerata Hospital, 62100 Macerata, Italy
Ferdinando Agresta, Department of Surgery, Adria Hospital, 45011 Adria, Rovigo, Italy
Fausto Catena, Department of Emergency and Trauma Surgery, Maggiore Hospital, 43126 Parma, Italy
Roberto Cirocchi, Departement of Digestive Surgery and Liver Unit, St. Maria Hospital, 05100 Terni, Perugia, Italy
Author contributions: Mandrioli M and Di Saverio S designed the study; Mandrioli M wrote the paper; Di Saverio S provided patients’ pictures and clinical cases from his own surgical procedures; Di Saverio S operated on all the patients included in the study; all authors performed the research and revised the manuscript; Inaba K edited the language.
Conflict-of-interest statement: The authors have nothing to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Salomone Di Saverio, MD, FACS, FRCS, Department of Emergency and General Surgery and Trauma Surgery Unit, C. A. Pizzardi Maggiore Hospital Trauma Center, Largo B. Nigrisoli 2, 40133 Bologna, Italy. salomone.disaverio@gmail.com
Telephone: +39-51-3172408 Fax: +39-51-6478412
Received: April 28, 2015
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
Processing time: 253 Days and 16 Hours
Abstract

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.

Keywords: Laparoscopy; Acute care surgery; Single-incision laparoscopic surgery; Natural orifice trans-luminal endoscopic surgery; Trauma

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.