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J Minim Access Surg. 2019 Jan-Mar;15(1):56-62. doi: 10.4103/jmas.JMAS_232_17.

Bedside diagnostic laparoscopy for critically ill patients in the Intensive Care Unit: Retrospective study and review of literature.

Author information

1
General, Emergency and Minimally Invasive Surgery Unit, Careggi University Hospital, Florence, Italy.
2
Department of Emergency, Intensive Care Unit and Regional ECMO Referral Centre, Careggi University Hospital, Florence, Italy.
3
Department of Heart and Vessels, Cardiac Intensive Care Unit, Careggi University Hospital, Florence, Italy.
4
Cardiac Surgery Unit, Department of Heart and Vessels, Careggi University Hospital, Florence, Italy.

Abstract

Background:

Bedside diagnostic laparoscopy could be helpful in extremely critically ill patients. The aim of this retrospective study is to evaluate the safety and diagnostic accuracy of bedside diagnostic laparoscopy in the identification of intra-abdominal pathology in critically ill patients and to compare its accuracy and outcomes with the ones of laparotomy.

Patients and Methods:

A retrospective review was conducted on the medical records of patients admitted to the Intensive Care Unit (ICU) of Careggi University Hospital and submitted to bedside diagnostic laparoscopy between January 2006 and May 2017. This group of patients was compared with a group of patients that were admitted to the ICU and submitted directly to explorative laparotomy for suspected intra-abdominal pathologies.

Results:

One hundred and twenty-nine patients (M/F = 81/48, mean age = 71.64 years) underwent bedside diagnostic laparoscopy in ICU. 154 patients instead were submitted directly to explorative laparotomy in operatory room (mean age 75.70 years, M/F = 94/60). Among the 129 patients submitted to bedside laparoscopy, 53.49% were positive for intra-abdominal pathologies whereas 46.51% were negative, while among the 154 patients submitted directly to laparotomy, 76.62% were positive for intra-abdominal pathologies whereas 23.38% were negative. In 55.03% of all patients submitted to bedside laparoscopy, a non-therapeutic laparotomy was avoided, while the 33.76% of patients submitted directly to laparotomy had a non-therapeutic laparotomy that could be avoidable.

Conclusions:

Our results pinpoint the advantages of performing bedside diagnostic laparoscopy in the ICU setting, which can be considered an option every time there is the suspicion of an intra-abdominal pathology.

KEYWORDS:

Bedside laparoscopy; Intensive Care Unit; critically ill patients; emergency laparoscopy

PMID:
29483381
DOI:
10.4103/jmas.JMAS_232_17
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Conflict of interest statement

Authors certify that there is no actual or potential conflict of interest in relation to this article and they state that there are no financial interests or connections, direct or indirect or other situations that might raise the question of bias in the work reported or the conclusions, implications or opinions stated – including pertinent commercial or other sources of funding for the individual author(s) or for the associated department(s) or organisation(s), personal relationships or direct academic competition.

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