Skip to main content
SpringerLink
Log in

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

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Navez B, Tassetti V, Scohy JJ, Mutter D, Guiot P, Evrard S, Marescaux J (1998) Laparoscopic management of acute peritonitis. Br J Surg 85:32–36

    Article  CAS  PubMed  Google Scholar 

  2. Cuschieri A (1998) Cost efficacy of laparoscopic vs. open surgery. Hospitals vs. community. Surg Endosc 12:1197–1198

    Article  CAS  PubMed  Google Scholar 

  3. Larsson PG, Henriksson G, Olsson M, Boris J, Ströberg P, Tronstad SE, Skullman S (2001) Laparoscopy reduces unnecessary appendicectomies and improves diagnosis in fertile women. A rondomized study. Surg Endosc 15:200–202

    Article  CAS  PubMed  Google Scholar 

  4. Di Saverio S (2014) Emergency laparoscopy: a new emerging discipline for treating abdominal emergencies attempting to minimize costs and invasiveness and maximize outcomes and patients’ comfort. J Trauma Acute Care Surg 77:338–350

    Article  PubMed  Google Scholar 

  5. Sauerland S, Agresta F, Bergamaschi R, Borzellino G, Budzynski A, Champault G, Fingerhut A, Isla A, Johansson M, Lundorff P, Navez B, Saad S, Neugebauer EA (2006) Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 20:14–29

    Article  CAS  PubMed  Google Scholar 

  6. Agresta F, Ansaloni L, Baiocchi GL, Bergamini C, Campanile FC, Carlucci M, Cocorullo G, Corradi A, Franzato B, Lupo M, Mandalà V, Mirabella A, Pernazza G, Piccoli M, Staudacher C, Vettoretto N, Zago M, Lettieri E, Levati A, Pietrini D, Scaglione M, De Masi S, De Placido G, Francucci M, Rasi M, Fingerhut A, Uranüs S, Garattini S (2012) Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell’Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc 26:2134–2164

    Article  PubMed  Google Scholar 

  7. Eysenbach G (2004) Improving the quality of web surveys: the checklist for reporting results of internet e-surveys (CHERRIES). J Med Internet Res. 6(3):E34. Published online 2004 Sep 29. doi:10.2196/jmir.6.3.e34 PMCID: PMC1550605

  8. Survey Reporting Guidelines. http://www.equator-network.org. Accessed 3 Oct 2015

  9. Kelley K, Clark B, Brown V, Sitzia J (2003) Good practice in the conduct and reporting of survey research. Int J Qual Health Care 15:261–266

    Article  PubMed  Google Scholar 

  10. Burns KEA, Kho ME (2015) How to assess a survey report: a guide for readers and peer reviewers. CMAJ 187:E198–205. doi:10.1503/cmaj.140545

    Article  PubMed  PubMed Central  Google Scholar 

  11. Polk HC Jr (2006) The evolution of guidelines toward standards of practice. Am Surg 72(1017–1030):1133–1148

    Google Scholar 

  12. Shih TH, Fan X (2009) Comparing response rates in email and paper surveys: a meta-analysis. Educ Res Rev 4:26–40

    Article  Google Scholar 

  13. Yarger JB, James TA, Ashikaga T, Hayanga AJ, Takyi V, Lum Y, Kaiser H, Mammen J (2013) Characteristics in response rates for surveys administered to surgery residents. Surgery 154(1):38–45. doi:10.1016/j.surg.2013.04.060

    Article  PubMed  Google Scholar 

  14. Johnson TP (2012) Response rates and nonresponse errors in surveys. JAMA 307:1805–1806

    Article  CAS  PubMed  Google Scholar 

  15. McCambridge J, Witton J, Elbourne DR (2014) Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. J Clin Epidemiol 67:267–277. doi:10.1016/j.jclinepi.2013.08.015

    Article  PubMed  PubMed Central  Google Scholar 

  16. Vettoretto N, Gobbi S, Corradi A, Belli F, Piccolo D, Pernazza G, Mannino L (2011) Italian Association of Hospital Surgeons (Associazione dei Chirurghi Ospedalieri Italiani). Consensus conference on laparoscopic appendectomy: development of guidelines. Colorectal Dis 13:748–754

    Article  CAS  PubMed  Google Scholar 

  17. Campanile FC, Catena F, Coccolini F, Lotti M, Piazzalunga D, Pisano M, Ansaloni L (2011) The need for new “patient-related” guidelines for the treatment of acute cholecystitis. World J Emerg Surg 6:44. doi:10.1186/1749-7922-6-44

    Article  PubMed  PubMed Central  Google Scholar 

  18. Campanile FC, Colobraro P, Foti N, Lupo M, Mandalà V (2012) Acute cholecystitis. In: Mandalà V (eds) The role of laparoscopy in emergency abdominal surgery, pp 33–47

  19. Campanile FC, Pisano M, Coccolini F, Catena F, Agresta F, Ansaloni L (2014) Acute cholecystitis: WSES position statement. World J Emerg Surg 9(1):58. doi:10.1186/1749-7922-9-58

    Article  PubMed  PubMed Central  Google Scholar 

  20. Campanile FC, Carrara A, Motter M, Ansaloni L, Agresta F (2014) Laparoscopy and acute cholecystitis: the evidence. In: Agresta F, Campanile FC, Vettoretto N (eds) Laparoscopic cholecystectomy. Springer, Berlin, pp 59–72

    Google Scholar 

  21. Agresta F, Campanile FC, Vettoretto N, Silecchia G, Bergamini C, Maida P, Lombari P, Narilli P, Marchi D, Carrara A, Esposito MG, Fiume S, Miranda G, Barlera S, Davoli M (2015) Italian surgical societies working group. Laparoscopic cholecystectomy: consensus conference-based guidelines. Langenbecks Arch Surg 400:429–453. doi:10.1007/s00423-015-1300-4

    Article  PubMed  Google Scholar 

  22. Sartelli M, Catena F, Ansaloni L, Leppaniemi A, Taviloglu K, van Goor H, Viale P, Lazzareschi DV, Coccolini F, Corbella D, de Werra C, Marrelli D, Colizza S, Scibè R, Alis H, Torer N, Navarro S, Sakakushev B, Massalou D, Augustin G, Catani M, Kauhanen S, Pletinckx P, Kenig J, Di Saverio S, Jovine E, Guercioni G, Skrovina M, Diaz-Nieto R, Ferrero A, Rausei S, Laine S, Major P, Angst E, Pittet O, Herych I, Agresta F, Vettoretto N, Poiasina E, Tepp J, Weiss G, Vasquez G, Vladov N, Tranà C, Delibegovic S, Dziki A, Giraudo G, Pereira J, Tzerbinis H, van Dellen D, Hutan M, Vereczkei A, Krasniqi A, Seretis C, Mesina C, Rems M, Campanile FC, Coletta P, Uotila-Nieminen M, Dente M, Bouliaris K, Lasithiotakis K, Khokha V, Zivanovic D, Smirnov D, Marinis A, Negoi I, Ney L, Bini R, Leon M, Aloia S, Huchon C, Moldovanu R, de Melo RB, Giakoustidis D, Ioannidis O, Cucchi M, Pintar T, Krivokapic Z, Petrovic J (2012) Complicated intra-abdominal infections in Europe: a comprehensive review of the CIAO study. World J Emerg Surg 7:36. doi:10.1186/1749-7922-7-36

    Article  PubMed  PubMed Central  Google Scholar 

  23. Csikesz NG, Tseng JF, Shah SA (2008) Trends in surgical management for acute cholecystitis. Surgery 144:283–289

    Article  PubMed  Google Scholar 

  24. Papadopoulos AA, Kateri M, Triantafyllou K, Ladas D, Tzathas C, Koutras M, Ladas SD (2006) Hospitalization rates for cholelithiasis and acute cholecystitis doubled for the aged population in Greece over the past 30 years. Scand J Gastroenterol 41:1330–1335

    Article  PubMed  Google Scholar 

  25. Sandzén B, Haapamäki MM, Nilsson E, Stenlund HC, Oman M (2013) Surgery for acute gallbladder disease in Sweden 1989-2006. A register study. Scand J Gastroenterol 48:480–486

    Article  PubMed  Google Scholar 

  26. Campbell EJ, Montgomery DA, Mackay CJ (2008) A national survey of current surgical treatment of acute gallstone disease. Surg Laparosc Endosc Percutan Tech 18:242–247

    Article  PubMed  Google Scholar 

  27. Ainsworth AP, Adamsen S, Rosenberg J (2007) Surgery for acute cholecysistis in Denmark. Scand J Gastroenterol 42:648–651

    Article  PubMed  Google Scholar 

  28. Navez B, Ungureanu F, Michiels M, Claeys D, Muysoms F, Hubert C, Vanderveken M, Detry O, Detroz B, Closset J, Devos B, Kint M, Navez J, Zech F, Gigot J-F (2012) Belgian group for endoscopic surgery (BGES) and the hepatobiliary and pancreatic section (HBPS) of the Royal Belgian Society of surgery. Surgical management of acute cholecystitis: results of a 2-year prospective multicenter survey in Belgium. Surg Endosc 26:2436–2445

    Article  PubMed  Google Scholar 

  29. Harboe KM, Bardram L (2011) The quality of cholecystectomy in Denmark: outcome and risk factors for 20,307 patients from the national database. Surg Endosc 25:1630–1641

    Article  PubMed  Google Scholar 

  30. Ward M, Gruppen L, Regehr G (2002) Measuring self-assessment: current state of the art. Adv Health Sci Educ Theory Pract 7:63–80

    Article  PubMed  Google Scholar 

  31. Agresta F, De Simone P, Leone L, Arezzo A, Biondi A, Bottero L, Catena F, Conzo G, Del Genio G, Fersini A, Guerrieri M, Illomei G, Tonelli P, Vitellaro M, Docimo G, Crucitti A (2004) Italian society of young surgeons (SPIGC). Laparoscopic appendectomy in Italy: an appraisal of 26.863 cases. J Laparoendosc Adv Surg Tech A 14:1–8

    Article  PubMed  Google Scholar 

  32. O’Malley E, Boyle E, O’Callaghan A, Coffey JC, Walsh SR (2013) Role of laparoscopy in penetrating abdominal trauma: a systematic review. World J Surg 37:113–122

    Article  PubMed  Google Scholar 

  33. Di Saverio S, Bendinelli C, Coniglio C, Biscardi A, Gordini G, Tugnoli G (2015) The brave challenge of NOM for abdominal GSW trauma and the role of laparoscopy as an alternative to CT scan. Ann Surg. doi:10.1097/SLA.0000000000001301

  34. Mandrioli M, Inaba K, Piccinini A, Biscardi A, Sartelli M, Agresta F, Catena F, Cirocchi R, Jovine E, Tugnoli G, Di Saverio S (2016) Advances in laparoscopy for acute care surgery and trauma. World J Gastroenterol 22(2):668–680

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Vennix S, Musters GD, Mulder IM, Swank HA, Consten EC, Belgers EH, van Geloven AA, Gerhards MF, Govaert MJ, van Grevenstein WM, Hoofwijk AG, Kruyt PM, Nienhuijs SW, Boermeester MA, Vermeulen J, van Dieren S, Lange JF, Bemelman WA, Ladies trial colloborators (2015) Laparoscopic peritoneal lavage or sigmoidectomy for perforated diverticulitis with purulent peritonitis: a multicentre, parallel-group, randomised, open-label trial. Lancet 386(10000):1269–1277

    Article  PubMed  Google Scholar 

  36. Vennix S, Lips DJ, Di Saverio S, van Wagensveld BA, Brokelman WJ, Gerhards MF, van Geloven AA, van Dieren S, Lange JF, Bemelman WA (2015) Acute laparoscopic and open sigmoidectomy for perforated diverticulitis: a propensity score-matched cohort. Surg Endosc. doi:10.1007/s00464-015-4694-8

  37. Di Saverio S, Vennix S, Birindelli A, Weber D, Lombardi R, Mandrioli M, Tarasconi A, Bemelman WA (2016) Pushing the envelope: laparoscopy and primary anastomosis are technically feasible in stable patients with Hinchey IV perforated acute diverticulitis and gross faeculent peritonitis. Surg Endosc. doi:10.1007/s00464-016-4869-y

Download references

Acknowledgments

Both the audits have been possible mainly thanks to all the colleagues of the Italian Surgical Units involved, which have taken the time to give their unique contribution and respond to the surveys. We also express our gratitude to the Presidents of the Scientific Societies that endorsed the audits and the consensus: part of this study has been presented during the ACOI National Congress in Genoa (June 2015), during the SICE National Congress in Ferrara (September 2015) and the SIC National Congress in Milan (October 2015), Italy.

Collaborator members of the Joined Italian Surgical Societies Working Group: Gabriele Anania, Nereo Vettoretto, Alberto Arezzo, Mario Campli, Carlo Bergamini, Michele Carlucci, Mauro Zago, Antonino Mirabella, Massimo Lupo, Micaela Piccoli, Luca Ansaloni, Gianfranco Cocorullo, Luca Baiocchi, Marco Allaix, Mario Saia and Gianluigi Luridiana.

Author’s contribution

Dr Agresta was the designer and the main coordinator of the surveys, contributed to the interpretation of the data, produced the article draft and supervised the subsequent revisions. Dr Campanile contributed to the interpretation of the data, edited the drafts and produced the manuscript revisions. Drs Podda, Cillara, Giaccaglia, Ciccoriti, Ioia, Mandalà and La Barbera have contributed to the data collection, the statistical analysis and drafted the first version of the manuscript. Drs Di Saverio, Pernazza, Birindelli and Sartelli contributed to the interpretation of the data and the editing of the article. All the authors approved the final article. All the Collaborators, as members of the Scientific Committee of the Joined Italian Surgical Societies Working Group, have reviewed all the results of the surveys.

Author information

Authors and Affiliations

  1. Department of General Surgery, ULSS19 del Veneto, Adria, RO, Italy

    Ferdinando Agresta

  2. Division of Surgery, Ospedale San Giovanni Decollato – Andosilla, Civita Castellana, VT, Italy

    Fabio Cesare Campanile

  3. Department of Surgical Science, University of Cagliari - General, Emergency and Laparoscopic Surgery - SS 554, Km 4.500, Monserrato, CA, Italy

    Mauro Podda

  4. UOC Chirurgia Generale PO SS. Trinità ASL8CA, Via Is Mirrionis 92, 09121, Cagliari, Italy

    Nicola Cillara

  5. General Surgery 1 Unit, Surgical Sciences Department, AO San Giovanni Addolorata, Rome, Italy

    Graziano Pernazza

  6. General Surgery Unit, Department of Surgical and Medical Sciences and Translational Medicine, Sant’Andrea Hospital, ‘Sapienza’ University of Rome, Rome, Italy

    Valentina Giaccaglia

  7. UOC Chirurgia Generale PO Santa Maria della Stella Loc. Ciconia, 05018, Orvieto, TR, Italy

    Luigi Ciccoritti

  8. ASST Bergamo EST – Bolognini Seriate, Seriate, Italy

    Giovanna Ioia

  9. Unit of General Surgery, Noto-Pasqualino Hospital, Via Dante Alighieri n 330, 90141, Palermo, Italy

    Stefano Mandalà & Camillo La Barbera

  10. S. Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy

    Arianna Birindelli

  11. Department of Surgery, Macerata Hospital, Macerata, Italy

    Massimo Sartelli

  12. General, Emergency and Trauma Surgery Service, Maggiore Hospital Regional Trauma Center, AUSL Bologna, l.go Nigrisoli 2, 40100, Bologna, Italy

    Salomone Di Saverio

Authors
  1. Ferdinando Agresta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabio Cesare Campanile
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mauro Podda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nicola Cillara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Graziano Pernazza
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Valentina Giaccaglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Luigi Ciccoritti
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Giovanna Ioia
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Stefano Mandalà
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Camillo La Barbera
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Arianna Birindelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Massimo Sartelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Salomone Di Saverio
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the Joined Italian Surgical Societies Working Group

  • Gabriele Anania
  • , Nereo Vettoretto
  • , Alberto Arezzo
  • , Mario Campli
  • , Carlo Bergamini
  • , Michele Carlucci
  • , Mauro Zago
  • , Antonino Mirabella
  • , Massimo Lupo
  • , Micaela Piccoli
  • , Luca Ansaloni
  • , Gianfranco Cocorullo
  • , Luca Baiocchi
  • , Marco Allaix
  • , Mario Saia
  •  & Gianluigi Luridiana

Corresponding author

Correspondence to Salomone Di Saverio.

Ethics declarations

Disclosures

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 and Salomone Di Saverio have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Agresta, F., Campanile, F.C., Podda, M. et al. 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. Surg Endosc 31, 1785–1795 (2017). https://doi.org/10.1007/s00464-016-5175-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-016-5175-4

Keywords

Search

Navigation