Impact of laparoscopic approach in emergency major abdominal surgery: single-centre analysis of 748 consecutive cases

BACKGROUND Acute abdominal pathology requiring emergency laparotomy is a common surgical presentation. Despite its widespread implementation in other surgical procedures, laparoscopy, rather than laparotomy, is sparingly used in major emergency surgery. This study reports outcomes and impact of rising use of laparoscopy for a single high-volume district general hospital. METHODS Data were retrieved from the prospective National Emergency Laparotomy Audit database for a 30-month period. Patient, procedural, and in-hospital outcome data were collated. Temporal trends were assessed and regression analysis conducted for clinical outcomes. RESULTS A total of 748 consecutive cases were recorded. There was an increasing use of laparoscopy over the study period, with 49% of cases attempted laparoscopically in the final six-month interval. Patients treated laparoscopically were at reduced risk of mortality (odds ratio 0.114, 95% confidence interval 0.024 to 0.550) and experienced reduced length of intensive care stay (regression coefficient -1.571, 95% confidence interval -2.625 to -0.517) in multivariate adjusted analysis. CONCLUSIONS Laparoscopy is safe and feasible in a large proportion of cases. It is associated with improved outcomes versus laparotomy.