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    • Therapeutic Laparoscopy from the Start Vs Diagnostic Laparoscopy First for Acute Abdomen: Would Outcomes Differ?

    Mr. Ayman M. A. Osman1 MD, MRCS (Eng); Mr. Sameh A. Mikhail1 MD, FRCS (Eng), MRCS (Eng); Mr. Mohamed E. Alkashty1 M.Sc.; Prof. Mohamed H.A. Fahmy1 MD.
    1Department of General Surgery, Faculty of Medicine, Cairo University, Egypt

    Objective: The outcomes of laparoscopic procedures in patients with acute abdomen vary widely. The aim of our study is to evaluate the diagnostic accuracy and therapeutic efficacy of laparoscopy in patients with acute abdomen, as well as to compare the short-term outcomes of laparoscopy between patients who undergo therapeutic laparoscopy from the start and those who undergo diagnostic laparoscopy first. Methods: One hundred and sixty-five patients who underwent laparoscopy for acute abdomen were prospectively studied. Patients were divided into two groups[A:patients who underwent therapeutic laparoscopy from the start; B:patients who underwent diagnostic laparoscopy first]. Patients were followed up for 6 months and a comparison between the study groups was carried out. Results: The diagnostic accuracy and therapeutic efficacy of laparoscopy were 97.3% and 75%, respectively. Group A included 90 patients(54.5%), whereas group B included 75 patients(45.5%). Conversion rate was lower in group A[n=13(14.4%)] compared to group B[n=35(46.7%)];P=0.001. Morbidity rate was relatively lower in group A[n=5 (5.5%)] compared to group B[n=9 (12%)];P=0.139. Postoperative hospital stay was shorter in group A[1-8 days(mean±SD=1.92±1.47)] compared to group B[1-21 days (mean±SD= 4.15±3.37)]; P=0.001. The overall mortality rate was 0.6%. Conclusion: Laparoscopy in acute abdomen is a relatively safe approach that has a high diagnostic accuracy and a good therapeutic efficacy. Therapeutic laparoscopy from the start appears to be associated with higher therapeutic efficacy, lower conversion rate, relatively lower morbidity rate and shorter hospital stays, compared to diagnostic laparoscopy first. Keywords: Therapeutic laparoscopy; Diagnostic laparoscopy; Acute abdomen; Accuracy; Efficacy; Outcomes.

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