Laparoscopic approach in gastrointestinal emergencies

Table 1 Treatment for acute cholecystitis depending on severity grading

Grade	Management
Grade I	Early laparoscopic cholecystectomy is the treatment of choice. Conservative treatment is indicated for high-risk patients
Grade II	Laparoscopic cholecystectomy carried out by expert surgeons is preferred. In cases of severe inflammation, the most adequate treatment is emergency laparoscopic cholecystectomy or cholecystostomy
Grade III	The treatment of choice consists of adequate organ support together with medical management and biliary drainage or emergency cholecystectomy. In the event of choleperitoneum after gallbladder perforation, emergency laparoscopic cholecystectomy is the treatment of choice

Table 2 Recommended treatment for acute cholangitis by severity

Grade	Management
Grade I	Initial medical management suffices in a majority of patients. Patients who do not respond to initial treatment undergo endoscopic, percutaneous or surgical drainage of bile ducts[28]
Grade II	After initiating medical treatment, patients undergo endoscopic, percutaneous or surgical T-tube drainage to avoid a deterioration of their condition
Grade III	Management entails organ supportive treatment together with urgent drainage of bile ducts. Once the patient is stable, endoscopic drainage must be performed. Percutaneous transhepatic cholangiography is indicated when the papilla is inaccessible and as a third-line approach when drainage is not possible or is contraindicated

Table 3 Selection criteria for a laparoscopic approach to incarcerated hernias

Criteria for a laparoscopic approach to treatment of an incarcerated ventral hernia[58]:

Absence of marked abdominal distension

Absence of peritonitis

Absence of clinical signs of intestinal ischaemia

Absence of high septic risk situations

Absence of major defects with loss of domain

Absence of haemodynamic instability and severe comorbidity

Morbid obesity, old age and debilitation are not considered contraindications to the procedure