[Acute abdomen: emergency laparoscopy or observation?]

Abstract

Acute abdomen accounts for 13-40% of all emergency surgical admissions. The aim of this prospective randomised controlled study was to examine the role of early laparoscopy in the management of acute abdomen compared with the more traditional active observation approach. From July 1993 to August 2004, 522 patients consecutively admitted with acute abdomen were randomised to either early laparoscopy (260 patients) (group 1) or active observation and non-invasive investigation (262 patients) (group 2). Baseline investigations included a full blood count, a pregnancy test in women of child-bearing age, and chest and/or abdominal radiography, if indicated clinically. Sixty-two patients in the laparoscopy group underwent a total of 116 radiological investigations compared with a total of 558 investigations in all patients in the observation group (p < 0.05). In the observation group, 34.7% of patients remained without a clear diagnosis compared with 4.2% of patients in the early laparoscopy group (p < 0.0001). The morbidity rate was 1.1% in group 1 and 27% in group 2 (p < 0.0001). The duration of hospital stay was significantly shorter in group 1 (3.1 vs 7.3 days) (p < 0.01). Eight patients in group 1 required readmission (total readmission: 46 days) compared with 58 patients in group 2 with a total readmission of 201 days (p < 0.05). Early laparoscopy is valuable in the management of acute abdomen. It affords significantly higher diagnostic accuracy and a greater improvement in quality of life than the more traditional observation approach.