1. Urgent Early Laparoscopic Reassessment George Ferzli MD, FACS Professor of Surgery SUNY Downstate

3. Acute Abdomen Diagnostic and Therapeutic Laparoscopy 17.5% 94.4% 98% 121 Salky B, 1998 20% 70% 65 Cuesta MA, 1998 12.1% 87.9% 100% 107 Cueto F, 1997 23% 73% 93% 255 Navez B, 1995 3.3% 96.7% 100% 61 Siragusa G, 1999 13% 87% 100% 200 Henry C, 1998 6.8% 88.2% 95.3% 365 Agresta F, 2000 Conversion to Laparotomy Laparoscopic treatment Definitive diagnosis Patients (n) Authors

4. Laparoscopy for Acute Abdomen in Early Postoperative Period Abdominal pain, sepsis. Fibrinous exudate (2), unknown (2) 1 - 7 4 Pecoraro A, Ferzli G et al. 2001 Pain (11), bleeding (2). Acute pancreatitis, SB injury, subhepatic hematoma, minor bile leak (6), unknown (2) 1 – 7 13 Simon P et al. 2000 Fever, elevated WBC, peritoneal signs. Tube misplacement or malfunction 1 – 14 3 Bauer F et al. 1998 Indication / Diagnosis Timing (POD #) No. of Patients (n) Author, Year

11. Small Bowel Obstruction Diagnostic and Therapeutic Laparoscopy 1 (1.5%) 30 (46%) 35 (54%) 65 139 Bailey IS, 1998 0 (0%) 6 (32%) 13 (68%) 19 19 Al-Mulhim A, 2000 3 (7.5%) 26 (65%) 14 (35%) 40 40 Leon EL, 1998 4 (8%) 36 (43%) 47 (57%) 83 83 Suter M, 2000 1 (1.5%) 11 (17.4%) 52 (82%) 63 136 Agresta F, 2000 4 (10%) 13 (32%) 24 (60%) 40 40 Strickland P, 1999 6 (9%) 31 (46%) 31 (46%) 68 150 Navez B, 1998 Iatrogenic bowel injury Converted to laparotomy Laparoscopic treatment Diagnostic laparoscopy Total # Author

15. Abdominal Trauma Diagnostic Laparoscopy (DL) Prospective study. Penetrating trauma only. 7 missed injuries in 54 pts. who had laparotomy based on DL. 20 (37) 57 (57) 43 (43) 100 Ivatury et al, 1993 Retrospective study. DL using eyepiece (no camera and monitor) 6 (26) 23 (62) 14 (38) 37 Gazzaniga et al, 1976 Prospective study. Blunt and penetrating trauma. High cost. 26 (30) 85 (47) 97 (53) 182 Fabian et al, 1993 Prospective study. 10 blunt and 11 penetrating traumas. Hard to see splenic, mesenteric and retroperitoneal injuries 9 (43) 18 (86) 3 (14) 21 Brandt et al, 1994 Retrospective study. Blunt trauma only. 25% had min to mod hemo- peritoneum, Rx close observation 0 66 (44) 84 (56) 150 Berci et al, 1991 Comments Unnecessary lap. n (%) Pos. DL, n (%) Neg. DL, n (%) # of patients Authors / year

16. Abdominal Trauma Diagnostic Laparoscopy (DL) Prospective study. CT prior to DL. 0 15 (100) 0 15 Townsend et al, 1993 Prospective study for abdominal GSW. Very sensitive and specific. Reduces unnecessary laparotomy, morbidity and hospital stay 7 (18) 42 (35) 79 (65) 121 Sosa et al, 1995 Prospective study. DL vs. DPL. Blunt and penetrating trauma. DL improved care in 8% cases. No better than DPL in blunt trauma. 2 (20) 33 (44) 42 (56) 75 Salvino et al, 1993 Prospective study. 19% significant injuries missed on DL 11 (34) 21 (66) 11 (34) 32 Rossi et al, 1993 Prospective study. Blunt and penetrating trauma. Difficulty in running bowel, seeing spleen and evacuating hematomas. 4 (13) 32 (82) 7 (18) 39 Livingston et al, 1992 Comments Unnecessary lap. n (%) Pos. DL, n (%) Neg. DL, n (%) # of patients Authors / year