Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma. This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement. A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic tool or helpful to identify further management steps and needs, resulting in improved outcomes, regardless of conversion. Appropriate patient selection, surgeon experience and rigorous minimally invasive surgical training, remain crucial factors to increase the adoption of laparoscopy in emergency general surgery and abdominal trauma. The WSES expert panel suggests laparoscopy as the first approach for stable patients undergoing emergency abdominal surgery for general surgery emergencies and abdominal trauma.

中文翻译：

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切塞纳指南：WSES 关于腹腔镜优先处理普外科急症和腹部创伤的共识声明


腹腔镜检查在选修环境中的几乎所有外科亚专科中被广泛采用。最初在小型腹部急症中寻找适应症，现已逐渐成为大多数择期普通外科手术的标准方法。尽管技术取得了许多进步并且接受度不断提高，但腹腔镜手术在急诊普通手术和腹部创伤中仍未得到充分利用。紧急剖腹手术的发病率和死亡率仍然很高。近年来，急诊和创伤外科医生对在急性手术环境中采用微创手术方法越来越感兴趣。本立场文件由世界急诊外科学会 (WSES) 支持，旨在对文献进行回顾，以就腹腔镜优先手术对于普通外科紧急情况需要紧急腹部手术的患者的适应症和益处达成共识或腹部外伤。本立场文件是根据 WSES 方法制定的。指导委员会进行了文献审查并起草了立场文件。随后，由 54 名专家组成的国际小组对手稿进行了批判性修改并进行了详细讨论，以就立场声明达成共识。从最初的 7409 项研究中选出了总共 323 项研究（系统评价和荟萃分析、随机临床试验、回顾性比较队列研究、病例系列）。有证据表明，对于因普通外科急症或腹部创伤而接受紧急腹部手术的稳定患者，腹腔镜手术有几个好处。选择稳定的患者似乎对于安全采用腹腔镜手术至关重要。 在血流动力学稳定的患者中，腹腔镜方法被发现作为一种治疗工具是安全、可行和有效的，或者有助于确定进一步的管理步骤和需求，从而无论是否转换，都能改善结果。适当的患者选择、外科医生经验和严格的微创手术培训仍然是增加腹腔镜在急诊普外科和腹部创伤中采用的关键因素。 WSES 专家小组建议腹腔镜检查作为因普通外科急症和腹部创伤而接受紧急腹部手术的稳定患者的首选方法。