Laparoscopy and Minimally Invasive Surgery Techniques in Acute Care Surgery

Advantages of the laparoscopic approach in various abdominal emergencies have led to increasing consensus on the need for more widespread adoption of minimally invasive techniques, with multiple studies reporting on their safety, feasibility, and improved outcomes compared to standard open surgery. A laparoscopic approach is now widely recommended in acute appendicitis, acute cholecystitis, and perforated peptic ulcers. It is gaining a larger role in other conditions, although some are still debated, including laparoscopic lavage for perforated diverticulitis, laparoscopic lysis for adhesive small bowel obstruction, and laparoscopic reduction and repair for obstructed hernias, amongst others. In patients in whom the diagnosis of continuing acute abdominal pain of less than 1-week duration remains elusive, diagnostic laparoscopy represents a valid option to consider, with a diagnostic accuracy ranging from 89 to 100%. In hemodynamically non-compromised patients, laparoscopy is a reliable tool for diagnosing patients with penetrating and blunt abdominal injury and, in selected patients, it may have a therapeutic role in the treatment of several types of injuries. Absolute contraindications to laparoscopy in acute care surgery include surgeons with little laparoscopic experience, hemorrhagic or septic shock with hemodynamic instability, and few other conditions.