Advances in laparoscopy for acute care surgery and trauma

The greatest advantages of laparoscopy when comparedto open surgery include the faster recovery times,shorter hospital stays, decreased postoperative pain,earlier return to work and resumption of normal dailyactivity as well as cosmetic benefits. Laparoscopy todayis considered the gold standard of care in the treatmentof cholecystitis and appendicitis worldwide. Laparoscopyhas even been adopted in colorectal surgery withgood results. The technological improvements in thissurgical field along with the development of moderntechniques and the acquisition of specific laparoscopicskills have allowed for its utilization in operations withfully intracorporeal anastomoses. Further progress inlaparoscopy has included single-incision laparoscopicsurgery and natural orifice trans-luminal endoscopicsurgery. Nevertheless, laparoscopy for emergencysurgery is still considered challenging and is usually notrecommended due to the lack of adequate experiencein this area. The technical difficulties of operating inthe presence of diffuse peritonitis or large purulentcollections and diffuse adhesions are also givenas reasons. However, the potential advantages oflaparoscopy, both in terms of diagnosis and therapy, areclear. Major advantages may be observed in cases withdiffuse peritonitis secondary to perforated peptic ulcers, for example, where laparoscopy allows the confirmationof the diagnosis, the identification of the position of theulcer and a laparoscopic repair with effective peritonealwashout. Laparoscopy has also revolutionized theapproach to complicated diverticulitis even whenintestinal perforation is present. Many other emergencyconditions can be effectively managed laparoscopically,including trauma in select hemodynamically-stablepatients. We have therefore reviewed the most recentscientific literature on advances in laparoscopy foracute care surgery and trauma in order to demonstratethe current indications and outcomes associated witha laparoscopic approach to the treatment of the mostcommon emergency surgical conditions.