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Surgical Endoscopy
Published in: Surgical Endoscopy 4/2017

01-04-2017

Current status of laparoscopy for acute abdomen in Italy: a critical appraisal of 2012 clinical guidelines from two consecutive nationwide surveys with analysis of 271,323 cases over 5 years

Authors: Ferdinando Agresta, Fabio Cesare Campanile, Mauro Podda, Nicola Cillara, Graziano Pernazza, Valentina Giaccaglia, Luigi Ciccoritti, Giovanna Ioia, Stefano Mandalà, Camillo La Barbera, Arianna Birindelli, Massimo Sartelli, Salomone Di Saverio, on behalf of the Joined Italian Surgical Societies Working Group

Published in: Surgical Endoscopy | Issue 4/2017

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Abstract

Background

Several authors have demonstrated the safety and feasibility of laparoscopy in selected cases of abdominal emergencies. The aim of the study was to analyse the current Italian practice on the use of laparoscopy in abdominal emergencies and to evaluate the impact of the 2012 national guidelines on the daily surgical activity.

Methods

Two surveys (42 closed-ended questions) on the use of laparoscopy in acute abdomen were conducted nationwide with an online questionnaire, respectively, before (2010) and after (2014) the national guidelines publication. Data from two surveys were compared using Chi-square or Fisher’s exact test, and data were considered significant when p < 0.05.

Results

Two-hundred and one and 234 surgical units answered to the surveys in 2010 and 2014, respectively. Out of 144,310 and 127,013 overall surgical procedures, 23,407 and 20,102, respectively, were abdominal emergency operations. Respectively 24.74 % (in 2010) versus 30.27 % (in 2014) of these emergency procedures were approached laparoscopically, p = 0.42. The adoption of laparoscopy increased in all the considered clinical scenarios, with statistical significance in acute appendicitis (44 vs. 64.7 %; p = 0.004). The percentage of units approaching Hinchey III acute diverticulitis with laparoscopy in 26–75 % of cases (14.0 vs. 29.7 %; p = 0.009), those with >25 % of surgeons confident with laparoscopic approach to acute diverticulitis (29.9 vs. 54 %; p = 0.0009), the units with >50 % of surgeons confident with laparoscopic approach to acute appendicitis, cholecystitis and perforated duodenal ulcer, all significantly increased in the time frame. The majority of respondents declared that the 2012 national guidelines influenced their clinical practice.

Conclusions

The surveys showed an increasing use of laparoscopy for patients with abdominal emergencies. The 2012 national guidelines profoundly influenced the Italian surgical practice in the laparoscopic approach to the acute abdomen.
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Metadata
Title
Current status of laparoscopy for acute abdomen in Italy: a critical appraisal of 2012 clinical guidelines from two consecutive nationwide surveys with analysis of 271,323 cases over 5 years
Authors
Ferdinando Agresta
Fabio Cesare Campanile
Mauro Podda
Nicola Cillara
Graziano Pernazza
Valentina Giaccaglia
Luigi Ciccoritti
Giovanna Ioia
Stefano Mandalà
Camillo La Barbera
Arianna Birindelli
Massimo Sartelli
Salomone Di Saverio
on behalf of the Joined Italian Surgical Societies Working Group
Publication date
01-04-2017
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 4/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-5175-4

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