Clinical presentation and efficacy of laparoscopy in patients with acute abdomen

Abstract

Objectives: To study the clinical presentation and efficacy of laparoscopy (diagnostic and therapeutic) in acute abdominal emergencies. Methodology: This prospective cross sectional study was conducted in Department of General Surgery, Hayatabad Medical Complex, Peshawar, Pakistan from January 2017 to January 2018. A sample of 72 patients was selected by using non probability convenient sampling technique. Patients presenting with acute abdomen were included in the study. A provisional diagnosis was made in all patients based on history, clinical examination and radiological features. Thereafter, laparoscopy was done within 48 hours of admission. Data were analyzed by SPSS version 16. Results: Out of 72 patients, there were 50(69.5%) females and 22(30.5%) males (with female to male ratio = 2.27:1). Mean age was 34.5 years. The most common presenting symptoms were abdominal pain (97.2%), nausea (79.1%), vomiting (75%), fever (69.4%), abdominal distension (34.7%), constipation (19.4%) and diarrhea (6.9%). Acute Appendicitis was most common pathology which was detected in 26(36%) patients. Out of total 72 patients with diagnostic laparoscopy, no intervention was done in three (4.16%) patients. Laparoscopic intervention was done in 48(66.66%) patients. Mini laparotomy was done in 11(15.2%) patients and formal laparotomy 10 (13.8%) patients. Twenty-one(29%) patients required conversion to open procedure. Conclusion: Laparoscopy in acute abdomen allows surgeon to directly view the entire abdominal cavity and at the same time therapeutic procedures can be performed thus decreasing the rate of complications due to unnecessary delay in diagnosis. A laparoscopic unit, which is completely dedicated to undertake laparoscopic procedures during day and night in abdominal emergencies will greatly enhance care in a large sub-set of patients.