Laparoscopic approach to Acute Abdomen: A Multicenter Study
Résumé
Abstract Background Laparoscopy has become a routine procedure for managing acute abdominal disease and can be considered an excellent therapeutic and additional diagnostic tool in select patients. Objective To determine the diagnostic and therapeutic value of laparoscopy for managing acute abdomen in Khartoum. Methods This was a prospective, descriptive, cross–sectional hospital-based study. The study was conducted in six centres around Khartoum State from October 2017 to October 2018. Patients whose laparoscopy was used for either diagnostic or therapeutic purposes for 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 three common clinical diagnoses were acute cholecystitis in 18 patients (30%), acute appendicitis in 13 patients (21.7%), and uncertain diagnosis in 11 patients (18.3%). The most common operative findings were the pathology of the appendix 14 (23.3%) and the gallbladder 14 (23.3%). The sensitivity, specificity, and accuracy of laparoscopy for acute abdomen were 93.5%, 42.9%, and 81.8%, respectively. The results indicated 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 patients (16.6%), 3 had lap adhesiolysis, 4 had perforated duodenal ulcers, 3 had sealed ulcers, and 1 had a graham patch. Another patient underwent foreign body (pin) removal after trauma with a pin gun, 1 had an ectopic pregnancy, and one had a cholecystostomy tube. A diagnosis was confirmed in 11 (18.3%) patients who were classified as uncertain preoperatively. The reported late complications were port site infection in 4 patients (6.7%) and incisional hernia in 1 patient (1.7%). The duration of surgery was less than 2 hours in 38 patients (63.3%). 47(78.3%) of the patients started oral feeding within 24 hours. The length of hospital stay was 1-2 days for 48 (80%) of the patients. Conclusion Emergency laparoscopy for acute abdomen surgery is safe and accurate; these techniques reduce the rate of unnecessary laparotomy and avoid delays in diagnosis.
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