నైరూప్య

Laparoscopic approach to acute abdomen: how clinical features and laboratory exams can help the emergency surgeon in a period characterized by limited resources.

Alberto Friziero

Introduction: In challenging times due to novel COVID-19 outbreaks worldwide, is important elaborate a new practical strategy in order to make the right decisions with limited resources. Due to the reduced availability of radiological procedures, especially in the emergency setting, clinical features and laboratory tests are back to guide the decision of surgeons. Methods: We retrospective analysed data of patients with a diagnosis of acute abdomen, who underwent laparoscopic surgery in urgency settings. Admission diagnoses, demographic and clinical features and biochemical parameters were retrospective collected, in order to analyse their relationship with the conversion risk. Results: We included 340 patients with a diagnosis of acute abdomen and managed with laparoscopic surgery. Age ≥ 49 years, ASA-score ≥ III, previous abdominal surgery, diffuse abdominal pain and CRP ≥ 66,05 mg/L have been found significantly predictive factors for risk of conversion whereas localized Blumberg’s sign, was significantly associated with lower risk of conversion. Conclusion: Laparoscopy can be used in certain contexts with an adequate patient selection. Age ≥ 49 years, ASA-score≥ III, previous abdominal surgery, diffuse abdominal pain, localized Blumberg, CRP ≥ 66,05 mg/L are useful for an adequate preoperative patient assessment, in order to choose the appropriate surgical approach. The importance of our findings is highlighted non-radiological parameters to choose the adequate surgical approach with a reduction of diagnostic work up, its risk of infective exposure, its cost and finally the waste of time with an improvement of surgical outcome.