The emergency laparoscopy

In 1991, after a suitable elective laparoscopic training, we pursued the use of laparoscopic technique to increase applications of minimally invasive surgery in many emergencies. Emergency minimally invasive procedures have been performed in 149 patients, without intra- or postoperative major drawbacks, Laparoscopic conversions occurred in 10 patients (6.7%). Three patients (2%) developed postoperative complications which needed re-operation for residual pelvic abscess. Indications for the laparoscopic approach included acute cholecystitis, unknown acute abdominal pain, questionable acute appendicitis or gynaecological diseases, adhesions with small bowel obstruction, perforated peptic ulcers, abdominal trauma with good haemodynamic conditions. In addition, small bowel resection, excision of Meckel's diverticulum and colostomy have been achieved in a laparoscopically assisted manner. In poorly characterized abdominal disease laparoscopy helps to define the correct diagnosis, avoiding unnecessary open surgery. However, open surgery conversion should be immediately carried out when poor laparoscopic view or intraoperative drawbacks occur: in an emergency setting it is not a complication, only a change in the size of the surgical wound.