Original article
Laparoscopy in the treatment of acute abdominal diseases

Background:
Laparoscopy is used more and more frequently in the treatment of acute abdominal diseases. Emergency laparoscopic procedures require proper experience and surgical skills because the intraoperative conditions are different than during elective procedures. The aim of the study was to present the material of emergency laparoscopic operations performed in the 2^nd Department of General Surgery of the Jagiellonian University from 1996 to 2005.

Materials and methods:
In the analysed period 5136 patients were operated on laparoscopically, including 2452 (47.7%) emergency cases of diffused or circumscribed peritonitis. The biggest group of patients was treated because of acute cholecystitis 67.8% (1662 patients, mean age 50.2 years). Laparoscopic appendectomies constituted 18.4% of all emergency procedures (450 patients, mean age 29.1 years). 9.6% of laparoscopic operations were performed in patients with pancreatitis (236 individuals, mean age 55.7 years). In case of biliary aetiology (157 patients) during 24 hours after admission we performed ERCP with endoscopic sphincterotomy and on the next day laparoscopic cholecystectomy. Laparoscopic lavage and flow drainage of abdominal cavity was performed in patients with alcohol related acute pancreatitis and diffused peritonitis. 2.4% of patients (59 individuals, mean age 42.7 years) were operated laparoscopically as emergency cases because of peptic ulcer perforation. The last group of 1.8% patients consisted of abdominal injury patients (45 individuals, mean age 38.5 years), who were treated laparoscopically under conditions of haemodynamic stability.

Results:
Mortality was noted only in patients suffering from acute pancreatitis (27), peptic ulcer perforation (2) and abdominal injury (11). There were no deaths among patients with acute cholecystitis and acute appendicitis. Laparoscopic technique was associated with low complication rates and short hospital stay. 3.1% of cholecystectomies, 4.5% of appendectomies and 21.3% of perforated ulcer operations were converted. Laparoscopy allowed unnecessary laparotomy to be avoided in 44% of abdominal injury patients.

Conclusion:
Laparoscopic technique is associated with very good results and can be used in many cases of acute abdominal diseases.