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Advances in laparoscopy for acute care surgery and trauma

World Journal of Gastroenterology 2016年第2期22卷 668-680页

作者： Matteo Mandrioli Kenji Inaba alice piccinini Andrea Biscardi Massimo Sartelli Ferdinando Agresta Fausto Catena Roberto Cirocchi Elio Jovine Gregorio Tugnoli Salomone Di Saverio Department of Emergency and General Surgery and Trauma Surgery Unit C.A.Pizzardi Maggiore Hospital Trauma Center40133 BolognaItaly Division of Trauma Surgery and Surgical Critical Care Department of SurgeryUniversity of Southern CaliforniaLos AngelesCA 90033United States Department of Surgery Macerata Hospital62100 MacerataItaly Department of Surgery Adria Hospital45011 AdriaRovigoItaly Department of Emergency and Trauma Surgery Maggiore Hospital43126 ParmaItaly Departement of Digestive Surgery and Liver Unit St.Maria Hospital05100 TerniPerugiaItaly

The greatest advantages of laparoscopy when compared to open surgery include the faster recovery times, shorter hospital stays, decreased postoperative pain, earlier return to work and resumption of normal daily activity as well as cosmetic benefits. Laparoscopy today is considered the gold standard of care in the treatment of cholecystitis and appendicitis worldwide. Laparoscopy has even been adopted in colorectal surgery with good results. The technological improvements in this surgical field along with the development of modern techniques and the acquisition of specific laparoscopic skills have allowed for its utilization in operations with fully intracorporeal anastomoses. Further progress in laparoscopy has included single-incision laparoscopic surgery and natural orifice trans-luminal endoscopic surgery. Nevertheless, laparoscopy for emergency surgery is still considered challenging and is usually not recommended due to the lack of adequate experience in this area. The technical difficulties of operating in the presence of diffuse peritonitis or large purulent collections and diffuse adhesions are also given as reasons. However, the potential advantages of laparoscopy, both in terms of diagnosis and therapy, are clear. Major advantages may be observed in cases with diffuse peritonitis secondary to perforated peptic ulcers,for example, where laparoscopy allows the confirmation of the diagnosis, the identification of the position of the ulcer and a laparoscopic repair with effective peritoneal washout. Laparoscopy has also revolutionized the approach to complicated diverticulitis even when intestinal perforation is present. Many other emergency conditions can be effectively managed laparoscopically, including trauma in select hemodynamically-stable patients. We have therefore reviewed the most recent scientific literature on advances in laparoscopy for acute care surgery and trauma in order to demonstrate the current indications and outcomes associated with a la

关键词： Laparoscopy Acute care surgery Singleincisionlaparoscopic surgery Natural orifice transluminalendoscopic surgery Trauma

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