Mini-laparotomy in emergency general surgery in a second-level hospital: a prospective study

Abstract

Background: Mini-laparotomy (ML) is one of the approaches aimed to reduce intraoperative stress and enhance recovery in surgical patients. The objective was to determine how safe and feasible ML access is in emergency surgery.

Methods: This prospective, two-group, parallel active-controlled study evaluated adult patients operated on for acute abdominal conditions at a second-level hospital. Patients explored with the use of ML and those having standard laparotomy access (SL) formed two arms of the study. Cases of abdominal malignancy, generalised peritonitis, and patients scheduled for relaparotomy procedure were excluded. Length of hospital stay and 30-day morbidity/mortality were primary endpoints. Secondary outcomes were operative time, estimated blood loss during the procedure, and postoperative pain control.

Results: Thirty-five patients were explored through ML, and 33 had an SL incision. The size of ML ranged from 6 to 12 cm, with the median being 10.5 cm. Employment of ML was associated with reduced length of stay (p=0.008), shorter operative time (p=0.003), and minimised need for opioid analgesia (p=0.008); however, the difference in postoperative complications was not statistically significant (ML: 20% versus SL: 27%, p=0.48) and mortality was similar in both groups (6%).

Conclusion: Our data demonstrate that ML is a safe technique that could be used for the treatment of urgent abdominal conditions in selected patients. Having comparable postoperative morbidity with the SL approach, it might lead to reduced pain and enhanced recovery after the procedure.

Keywords: Mini-laparotomy, standard laparotomy, emergency general surgery