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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

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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.


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.


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.


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.

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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.

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Correspondence to Salomone Di Saverio.

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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.

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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).

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