Published online Mar 7, 2016. doi: 10.3748/wjg.v22.i9.2701
Peer-review started: October 5, 2015
First decision: November 27, 2015
Revised: December 24, 2015
Accepted: January 11, 2016
Article in press: January 11, 2016
Published online: March 7, 2016
This review focuses on the laparoscopic approach to gastrointestinal emergencies and its more recent indications. Laparoscopic surgery has a specific place in elective procedures, but that does not apply in emergency situations. In specific emergencies, there is a huge range of indications and different techniques to apply, and not all of them are equally settle. We consider that the most controversial points in minimally invasive procedures are indications in emergency situations due to technical difficulties. Some pathologies, such as oesophageal emergencies, obstruction due to colon cancer, abdominal hernias or incarcerated postsurgical hernias, are nearly always resolved by conventional surgery, that is, an open approach due to limited intraabdominal cavity space or due to the vulnerability of the bowel. These technical problems have been solved in many diseases, such as for perforated peptic ulcer or acute appendectomy for which a laparoscopic approach has become a well-known and globally supported procedure. On the other hand, endoscopic procedures have acquired further indications, relegating surgical solutions to a second place; this happens in cholangitis or pancreatic abscess drainage. This endoluminal approach avoids the need for laparoscopic development in these diseases. Nevertheless, new instruments and new technologies could extend the laparoscopic approach to a broader array of potentials procedures. There remains, however, a long way to go.
Core tip: Laparoscopic surgery represents a technological revolution in the management of gastrointestinal conditions. However, the use of this minimally invasive technique has not yet been extended to emergency situations. The most likely reason is the long learning curve and the even longer operative time of emergency laparoscopy compared to elective laparoscopy.