Current status of laparoscopy for acute abdomen in Italy: a critical appraisal of 2012 clinical guidelines from two consecutive nationwide surveys with analysis of 271,323 cases over 5 years.

BACKGROUND: Several authors have demonstrated the safety and feasibility of laparoscopy in selected cases of abdominal emergencies. The aim of the study was to analyse the current Italian practice on the use of laparoscopy in abdominal emergencies and to evaluate the impact of the 2012 national guidelines on the daily surgical activity. METHODS: Two surveys (42 closed-ended questions) on the use of laparoscopy in acute abdomen were conducted nationwide with an online questionnaire, respectively, before (2010) and after (2014) the national guidelines publication. Data from two surveys were compared using Chi-square or Fisher's exact test, and data were considered significant when p < 0.05. RESULTS: Two-hundred and one and 234 surgical units answered to the surveys in 2010 and 2014, respectively. Out of 144,310 and 127,013 overall surgical procedures, 23,407 and 20,102, respectively, were abdominal emergency operations. Respectively 24.74 % (in 2010) versus 30.27 % (in 2014) of these emergency procedures were approached laparoscopically, p = 0.42. The adoption of laparoscopy increased in all the considered clinical scenarios, with statistical significance in acute appendicitis (44 vs. 64.7 %; p = 0.004). The percentage of units approaching Hinchey III acute diverticulitis with laparoscopy in 26-75 % of cases (14.0 vs. 29.7 %; p = 0.009), those with >25 % of surgeons confident with laparoscopic approach to acute diverticulitis (29.9 vs. 54 %; p = 0.0009), the units with >50 % of surgeons confident with laparoscopic approach to acute appendicitis, cholecystitis and perforated duodenal ulcer, all significantly increased in the time frame. The majority of respondents declared that the 2012 national guidelines influenced their clinical practice. CONCLUSIONS: The surveys showed an increasing use of laparoscopy for patients with abdominal emergencies. The 2012 national guidelines profoundly influenced the Italian surgical practice in the laparoscopic approach to the acute abdomen.

Single incision laparoscopic surgery cholecystectomy: a preliminary experience.

BACKGROUND: Single incision laparoscopic surgery (SILS) has recently been introduced as an alternative to natural orifice transluminal endoscopic surgery for scarless abdominal surgery. We report our preliminary experience with SILS cholecystectomy. METHODS: Six patients underwent elective laparoscopic cholecystectomy for symptomatic gallbladder stones through a single umbilical incision. RESULTS: All procedures were completed successfully except for 1 case of gallbladder wall perforation by cautery that required 2 additional 5-mm ports. Mean operating time was 50 min (range, 20-110 min). There were no postoperative complications. Four patients were discharged within 24 hours and the other 2 within 48 hours. The cosmetic results were scored as excellent by all patients. CONCLUSIONS: SILS cholecystectomy is feasible with standard laparoscopic instruments, and provides a promising alternative to natural orifice transluminal endoscopic surgery for scarless laparoscopic cholecystectomy.