Background The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. Methods Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. Results A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases ( p < 0.0001), diabetes ( p < 0.0001), and severe chronic obstructive airway disease ( p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS ( p < 0.0001), PIPAS score ( p < 0.0001), WSES sepsis score ( p < 0.0001), qSOFA ( p < 0.0001), and Tokyo classification of severity of acute cholecystitis ( p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. Conclusions The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands. Graphical abstract

Upper gastrointestinal bleeding (UGIB) is one of the most common emergencies. Risk stratification is essential in patients with this potentially life-threatening condition. The aim of this prospective study was to evaluate the usefulness of the admission venous lactate level in predicting clinical outcomes in patients with UGIB. All consecutive adult patients hospitalized due to UGIB were included in the study. The clinical data included the demographic characteristics of the observed population, etiology of UGIB, need for surgical intervention and intensive care, bleeding recurrence, and mortality rates. Venous lactate was measured in all patients on admission. Logistic regression analyses were used to calculate the odds ratios (OR) of lactate levels for all outcomes. The receiver operating characteristic (ROC) curve was used to determine the accuracy of lactate levels in measuring clinical outcomes, while Youden index was used to calculate the best cut-off points. A total of 221 patients were included in the study (151M; 70F). There were 24 cases of UGIB recurrence (10.8%), 19 patients (8.6%) required surgery, and 37 individuals (16.7%) required intensive care. Mortality rate was 11.3% (25 cases). The logistic regression analysis showed statistically significant association between admission venous lactate and all clinical outcomes: mortality (OR = 1.39, 95%CI: 1.22–1.58, p < 0.001), recurrence of bleeding (OR = 1.16, 95%CI: 1.06; 1.28, p = 0.002), surgical intervention (OR = 1.17, 95%CI: 1.06–1.3, p = 0.002) and intensive care (OR = 1.33, 95%CI: 1.19–1.5, p < 0.001). The ROC curve analysis showed a high predictive value of lactate levels for all outcomes, especially mortality: cut-off point 4.3 (AUC = 0.82, 95%CI: 0.72–0.92, p < 0.001) and intensive care: cut-off point 4.2 (AUC = 0.76, 95%CI: 0.66–0.85, p < 0.001). Admission venous lactate level may be a useful predictive factor of clinical outcomes in patients with UGIB.

Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted. This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018. A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28–66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4–10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO2) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0–1, 22.7% for those who had scores of 2–3, 46.8% for those who had scores of 4–5, and 86.7% for those who have scores of 7–8. The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.

INTRODUCTION:Laparoscopic splenectomy (LS) is the gold standard in treating immune thrombocytopenia (ITP). However, there are still some problems in decision-making when considering LS in patients with a very low platelet count (PLT).AIM:To evaluate safety outcomes of LS in patients with severe ITP and very low PLT in comparison to those with higher PLT.MATERIAL AND METHODS:We retrospectively analyzed consecutive patients who underwent LS in a single institution between April 1998 and December 2017. Perioperative care was based on an algorithm developed at our department which takes into consideration the patient's PLT level. Patients were divided into 2 groups depending on the PLT level (cut-off point 50,000/mm3).RESULTS:The mean operative time in the low PLT group and high PLT group was 90 ±42.1 min and 95 ±45 min, respectively (p = 0.59). Intraoperative blood loss was 144 ±226.1 ml in the low PLT group and 83 ±161.24 ml in the high PLT group (p = 0.23). Complications occurred in 5 (9.09%) patients in the low PLT group and 16 (11.51%) in the high PLT group (p = 0.67). There were no conversions in the group with lower PLT, while 2 patients in the group with higher PLT had to be converted to open surgery (p = 0.38). Patients with low PLT preoperatively more often required perioperative platelet transfusions (13 vs. 1, p < 0.001).CONCLUSIONS:Laparoscopic splenectomy is safe and feasible treatment in patients with ITP regardless of the PLT level. Still, patients with critical ITP and marginally low PLT require special awareness.

Introduction: Over the past years the incidence of colorectal cancers has increased worldwide. Currently it is the most common gastrointestinal malignancy worldwide. The laparoscopic approach has become the gold standard for surgical treatment. However, a recently published meta-analysis showed no difference in short-and long-term oncological outcomes of laparoscopy for treating rectal cancer. Aim: To assess current literature on short-term outcomes of rectal cancer treatment using laparoscopic surgery in comparison to the open approach. Material and methods: We performed a systematic review and meta-analysis according to the PRISMA guidelines. The primary outcomes of interest were morbidity and short-term complications. Results: We identified 4,328 potential references. In the end we included 13 randomized controlled trials (RCTs). We did not find any significant differences in terms of morbidity, haemorrhage, ureter injury, anastomotic leakage, mortality, intra-abdominal abscess or postoperative ileus. We found significant differences in the rate of surgical site infections, operative time, blood loss, length of hospital stay and time to first bowel movement. Conclusions: This systematic review based on available RCTs confirms that laparoscopic rectal cancer surgery is associated with short-term outcomes comparable to the open approach. Moreover, in some aspects it provides better results (e.g. functional postoperative recovery, lower rate of surgical site infections (SSIs)). The quality of evidence is high; therefore in our opinion it is very unlikely that future trials will alter these results, and for this reason the laparoscopic approach can be considered the gold standard for the treatment of the majority of patients.

Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments.

Introduction Thanks to laparoscopy and enhanced recovery protocols (ERAS) it is possible to shorten hospitalization. Therefore, it seems reasonable to search for new early markers of infectious complications in order to select patients who are prone to development of complications. Aim To assess the usefulness of serum levels of C-reactive protein, interleukin-6 and procalcitonin as early indicators of infectious complications in patients after laparoscopic colorectal surgery with ERAS. Material and methods The prospective analysis included consecutive patients who underwent laparoscopic colorectal cancer resection. The following parameters were included in the analysis: C-reactive protein (CRP), interleukin 6 (IL-6) and procalcitonin measured on postoperative days (PODs) 1, 2, 3. Patients were divided into two groups: uncomplicated (group 1) and complicated (group 2). The difference in levels of the markers and the dynamics of changes observed in both groups were analyzed. Results Group 1 comprised 34 patients, and group 2 consisted of 17 patients. A significant increase of both absolute values and delta increments on all postoperative days was noted. ROC curve analysis showed that the best cut-off values indicating an infectious process were: CRP 129 mg/l on POD3 (92% sensitivity/80% specificity), IL-6 of 78 pg/ml on POD2 (91% sensitivity/97% specificity) and PCT 0.24 ng/ml on POD3 (93% sensitivity/68% specificity). Conclusions Our study showed that regular measurement of all analyzed markers in the early postoperative days may be beneficial in the detection of postoperative infectious complications. Further studies are needed to fully assess the role of routine biochemical measurements in the postoperative period after laparoscopic surgery with the ERAS protocol.

Background: Nowadays laparoscopy is used frequently not only in elective surgery but also in abdominal emergencies, including acute appendicitis. There are several techniques used to close the appendicular stump during laparoscopic appendectomy. The aim of the study was to present and compare the results of minimally invasive appendectomies performed with the use of endoscopic staplers (group A), titanium endoclips (group B) and invaginating sutures (group C).Methods: Three hundred seven patients (mean age = 35.6; SD = 15.9; 178 males, 129 females) operated on laparoscopically for acute appendicitis from January 2010 to December 2014 at our department were included in the study. We reviewed retrospectively patients' data including: age, sex, duration of the surgical procedure and hospital stay, mortality, intraoperative and postoperative complication rates in all analyzed groups.Results: There were 102 patients in group A (mean age = 35.8; SD = 15.4; 57 males, 45 females). The average hospital stay in this group was 4.3 days (SD = 1.7), average operation time was 62.0 min (SD = 15), postoperative complication rate was 5.9 %. There were 160 patients in group B (mean age = 35.0; SD = 16.3; 96 males, 64 females). The average hospital stay in this group was 3.6 days (SD = 1.4), average operation time was 62.9 min (SD = 13.5), postoperative complication rate was 5.6 %. There were 45 patients in group C (mean age = 37.3; SD = 15.8; 25 males, 20 females). The average hospital stay in this group was 4.6 days (SD = 2.0), average operation time was 73.9 min (SD = 20.8), postoperative complication rate was 6.7 %. There were no intraoperative complications and no mortality in all compared groups of patients operated on laparoscopically for acute appendicitis.Conclusions: Laparoscopic appendectomies with application of different techniques for closure of the appendicular stump are useful and safe. In our study the shortest hospital stay and lowest complication rate were observed in patients operated with the use of titanium endoclips. The longest hospital stay and operation time and the highest complication rate was associated with the use of invaginating sutures.

UNLABELLED:It is generally agreed that laparoscopic appendectomy is a valuable operative method. The aim of the study was to evaluate cost-effectiveness of three different techniques used to close the appendix stump.MATERIAL AND METHODS:We conducted a retrospective study that compared three groups of patients who were operated on laparoscopically for acute appendicitis in 2013 at our institution. We used an endoscopic clip to close the appendix stump in the first group (n=20), endoscopic stapler was applied in the second group (n=20), and in the third group of patients the appendix base was closed with a laparoscopic suture (n=20). These groups were matched by age, sex and BMI.RESULTS:The average operative cost was the highest in the second group. Cost of the laparoscopic appendectomy with the application of the endoscopic clip was significantly lower (first group) and comparable to the third group. Observed differences in total hospitalization costs were associated only with the chosen appendix stump closure technique.CONCLUSIONS:Clip closure of the appendix base is an easy and cost-effective procedure. The laparoscopic suture technique is the cheapest but technically demanding. According to our experience endoscopic stapler may be useful in some cases, although it is the most expensive method.

UNLABELLEDNowadays laparoscopy is used frequently not only in elective surgery but also in abdominal emergencies, including acute appendicitis. There are several techniques used to close the appendicular stump during laparoscopic appendectomy. The aim of the study was to present the results of minimally invasive appendectomies performed with the use of titanium clips.MATERIAL AND METHODSPatients operated on laparoscopically for acute appendicitis with the application of titanium clips between October 2012 and December 2013 were included in the study. We reviewed retrospectively patients` data including: age, sex, duration of the surgical procedure and hospital stay, mortality, intraoperative and postoperative complication rates.RESULTSThere were 93 patients (mean age=33.8 years, SD=15.23) in the analyzed group, including 60 men (mean age=33.5 years, SD= 15.07) and 33 women (mean age=33.9 years SD=15.26). The average duration of the surgical procedure was 66 min (SD= 33.15). The average length of hospital stay was 3.38 days (SD=1.62). No intraoperative complications were observed in the analyzed group. Post-operative complication rate was low (6 cases, 6.5%). No mortality was observed.CONCLUSIONSLaparoscopic appendectomy with the application of titanium clips for closure of the appendicular stump is safe, associated with low complication rates and should be considered as a routine technique in everyday surgical practice.

Introduction: The use of tension-free inguinal hernia repair techniques using commercially available implants is now rather common. However, it is widely accepted that the use of biomaterials should be limited to non-infected surgical fields. As such, most current studies pertain to the application of various implants during the surgical repair of uncomplicated hernias.Aim: To compare the short-and long-term outcomes of incarcerated inguinal hernia repair using the Lichtenstein or Bassini technique.Material and methods: Between 1997 and 2012, 107 patients were operated on an emergency basis due to the incarceration of inguinal hernias - 105 subjects were included for further analysis in our study.Results: Postoperative complications were observed in 13 out of the 84 (15.5%) patients subjected to Lichtenstein repair In 9 of these patients (10.7%), morbidity was associated with the surgical wound. In 2 cases (2.4%), a small inflammatory infiltration was observed and resolved within a few days. Serous fluid accumulation within the wound was observed in 3 patients (3.6%), but the fluid was successfully drained by puncture. Finally, hematorna formed in 4 cases (4.8%). In total, 4 complications (19%) were recorded in the group of 21 patients who were operated on with the Bassini technique. In 3 of these cases (14.3%), the complications were related to suppuration of the surgical wound.Conclusions: Polypropylene mesh may be safely implanted during the repair of incarcerated hernia and this approach is reflected by satisfactory long-term outcomes.

UNLABELLEDOne of the most commonly performed surgeries in general surgery wards with laparoscopic technique as a method of choice is gall-bladder excision. In addition to -the commonly used conventional laparoscopic cholecystectomy single incision laparoscopic cholecystectomy is getting more and more attention. Despite many works and studies comparing these methods, there is still a shortage of results assessing efficiency of this new surgical technique. The aim of the study was to evaluate cost-effectiveness of this method in Polish financial reality. We have analyzed costs of three different surgical techniques: conventional (multi- incision) laparoscopic cholecystectomy, SILC and 'no-port' SILC.MATERIAL AND METHODSWe conducted a retrospective study that compared three groups of patients who underwent treatment with conventional laparoscopic cholecystectomy (n=20), SILC (n=20) and no-port SILC (n=20). These groups were matched by age, sex and BMI. Following parameters were analyzed: complication rate, operative time, operative costs, length of hospital stay, hospitalization costs. The SILC cases were performed with one of the three-trocar SILC ports available on the market. The 'no- port' SILC cases were performed by single skin incision in the umbilicus, insertion of one 10 mm trocar for the operating instrument, another instrument and scope were inserted directly thorough small incisions in the aponeurosis without a dedicated portRESULTSThe average operative cost was significantly higher in the SILC group comparing to the conventional laparoscopy group and the no-port SILC group. There was no significant difference in complication rate, operative time, length of hospital stay, or hospitalization costs between the three groupsCONCLUSIONSCurrently the cost of the dedicated SILC port does not allow a regular use of this procedure in Polish financial reality. According to our experience improved cosmesis is the only advantage of the single incision laparoscopy, therefore we believe that it is reasonable to consider this technique in a a very selected group of patients.

UNLABELLED:Laparoscopic single access technique is a next step in development of minimally invasive surgery. The aim of the study was to present results of different laparoscopic single incision procedures and evaluate application of this technique.MATERIAL AND METHODS:102 patients (15 males and 87 females) who underwent laparoscopic single incision procedure from 15th October 2009 to 31st December 2012 were included in the study.RESULTS:In the analyzed period we performed 72 cholecystectomies (70.6%), 8 left adrenalectomies (7.8%), 3 right adrenalectomies (2.9%), 7 splenectomies (6.9%), 5 spleen cysts unroofings (4.9%), 2 appendectomies (2%), 1 Nissen fundoplication procedure (1%), 1 removal of the adrenal cyst (1%) and 3 concomitant splenectomies and cholecystectomies (2.9%). There were 3 technical conversions to multiport laparoscopy, but no conversion to open technique. Complications were observed in 5 patients (4.9%). Average operation time was 79 min (SD=40), average hospitalization time 2.4 day (SD=1.4).CONCLUSIONS:Laparoscopic single incision technique is a safe method and can be used as a reasonable alternative to multiport laparoscopy in different minimally invasive procedures especially in young patients to whom an excellent cosmetic effect is particularly important.

There are just few studies regarding the use of tension-free techniques during the emergency operations of strangulated hernias among all the articles on the subject of surgical herniorrhaphy. Assessment of safety of the use of mono- or double-filament polypropylene mesh for the repair of strangulated hernia constituted the aim of the study. There were 81 inguinal and 34 other hernias (mostly incisional) in the group of 115 surgically treated patients with strangulated abdominal wall hernias. During the surgical operation in 84 patients strangulated bowel loop was reduced, 22 patients were treated with reduction of larger omentum, 7 patients required bowel resection (including 2 resections of Meckel diverticulum) and 2 resections of the omentum. All patients received prophylactic dose of broad-spectrum antibiotic during the surgical procedure and for 2-4 days after the operation. There were 15 cases of surgical site complications noted. Only two such cases (purulent infection in two patients and necrosis of wound margins in one) constituted potential threat to the implant. The incidence of local surgical complications was somewhat lower in the group of inguinal hernias as compared to the others (11.1% vs. 17.6%). The data from our study confirm the fact that mono- or double-filament polypropylene mesh can be safely used for the repair of strangulated hernia and the risk of local surgical complications is scant.

Introduction: The introduction of minimally invasive procedures has changed the pattern of surgical complications.Some were only incidentally described in open surgery. Others significantly changed in character or incidence.Aim: We present the incidence, character and dynamics of important complications of laparoscopic procedures withinthe entire period of application of this technique.Material and methods: Patients operated on laparoscopically in the 2nd Department of General Surgery of theJagiellonian University between 1992 and 2009 (n = 8732) were included in the study. In order to follow the dynamicsof complication rates the study period was divided into 3 sub-periods: 1) 1992-1997, 2) 1998-2003, 3) 2004-2009.There were 2343 laparoscopic procedures performed in the 1st period, 3310 in the 2nd and 3079 in the 3rd.Results: The proportion of procedures other than cholecystectomy gradually increased: 1) –22.79%, 2) –31.81%,3) –40.05%. Overall conversion rate was 2.91%; in the 1st period it was 3.97%, in the 2nd 1.81%, and in the 3rd 3.28%.Complication-driven conversion rates were 0.60%, 0.27%, and 0.26%, respectively. Bleeding and biliary tree injurieswere the most common causes. Complications requiring reoperations occurred in 0.48% of patients, and theirincidence remained constant. Haemorrhage and intra-abdominal abscesses were observed most often. Use oflaparoscopic technique in their management increased in consecutive periods from 20% in the 1st, 45.83% in the 2nd,to 53.57% in the 3rd time period.Conclusions: The introduction of new advanced procedures did not increase overall complication rate. Change in theirnature and more common use of laparoscopic technique in their management were noted.

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Introduction: Laparoscopy is now used more and more frequently in the treatment of patients with acute surgical abdominal diseases. Acute appendicitis is the commonest indication for emergency abdominal surgery. Aim: To present the results of the treatment of patients with acute appendicitis and to compare the results of laparoscopic and open appendectomies. Material and methods: Seven hundred and fifteen patients with acute appendicitis were operated on in the 2(nd) Department of General Surgery of the Jagiellonian University from 1996 to 2005. We performed 450 laparoscopic (63%) and 265 open procedures (37%). There were 249 females (55%) and 201 males (45%) in the laparoscopic group. Open approach was used in 109 women (41%) and 156 men (59%). The average age of patients in the laparoscopic group was 29.1 years (SD = 14.9) and 35.4 years (SD = 18.2) in the open group. Results: Laparoscopic appendectomies were performed more and more frequently over the analyzed period. The complication rate in the minimally invasive procedure group was 3.3% as compared to 15.1% in the open group. The average hospital stay was shorter after laparoscopic appendectomy (4.8 vs. 10.4 days). The conversion rate was low (4.5%). Conclusions: Laparoscopic appendectomy is a safe procedure associated with shorter hospital stay and decreased complication rates as compared to the open procedure.

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Background. Laparoscopy is used more and more frequently in the treatment of acute abdominal diseases. Emergency laparoscopic procedures require proper experience and surgical skills because the intraoperative conditions are different than during elective procedures. The aim of the study was to present the material of emergency laparoscopic operations performed in the 2(nd) Department of General Surgery of the Jagiellonian University from 1996 to 2005. Materials and methods: In the analysed period 5136 patients were operated on laparoscopically, including 2452 (47.7%) emergency cases of diffused or circumscribed peritonitis. The biggest group of patients was treated because of acute cholecystitis 67.8% (1662 patients, mean age 50.2 years). Laparoscopic appendectomies constituted 18.4% of all emergency procedures (450 patients, mean age 29.1 years). 9.6% of laparoscopic operations were performed in patients with pancreatitis (236 individuals, mean age 55.7 years). In case of biliary aetiology (157 patients) during 24 hours after admission we performed ERCP with endoscopic sphincterotomy and on the next day laparoscopic cholecystectomy. Laparoscopic lavage and flow drainage of abdominal cavity was performed in patients with alcohol related acute pancreatitis and diffused peritonitis. 2.4% of patients (59 individuals, mean age 42.7 years) were operated laparoscopically as emergency cases because of peptic ulcer perforation. The last group of 1.8% patients consisted of abdominal injury patients (45 individuals, mean age 38.5 years), who were treated laparoscopically under conditions of haemodynamic stability. Results. Mortality was noted only in patients suffering from acute pancreatitis (27), peptic ulcer perforation (2) and abdominal injury (11). There were no deaths among patients with acute cholecystitis and acute appendicitis. Laparoscopic technique was associated with low complication rates and short hospital stay. 3.1% of cholecystectomies, 4.5% of appendectomies and 21.3% of perforated ulcer operations were converted. Laparoscopy allowed unnecessary laparotomy to be avoided in 44% of abdominal injury patients. Conclusion: Laparoscopic technique is associated with very good results and can be used in many cases of acute abdominal diseases.

Wprowadzenie: Technikę laparoskopową obecnie coraz szerzej stosuje się w leczeniu ostrych schorzeń jamy brzusznej. Operacje tego typu wymagają dużego doświadczenia, gdyż często warunki śródoperacyjne odbiegają znacznie od obrazu stwierdzanego podczas zabiegów planowych. Celem pracy było przedstawienie materiału osób operowanych laparoskopowo ze wskazań doraźnych w II Katedrze Chirurgii UJ CM w latach 1996–2005. Materiał i metody: W analizowanym okresie operowano laparoskopowo 5136 chorych, w tym 2452 (47,7%) w trybie doraźnym z powodu rozlanego lub ograniczonego zapalenia otrzewnej. Wśród operowanych doraźnie najliczniejszą grupą były przypadki ostrego zapalenia pęcherzyka żółciowego 67,8% (1662 pacjentów, średni wiek 50,2 roku). Appendektomie laparoskopowe stanowiły 18,4% zabiegów (450 chorych, średni wiek 29,1 roku). Wykonano 9,6% operacji laparoskopowych u pacjentów z ostrym zapaleniem trzustki (236 osób, średni wiek 55,7 roku). W przypadku etiologii żółciowej (157 pacjentów) w pierwszej dobie po przyjęciu przeprowadzono endoskopową cholangiopankreatografię wsteczną (ECPW) z papillotomią, a w następnej cholecystektomię. W poalkoholowym ostrym zapaleniu trzustki w razie rozlanego zapalenia otrzewnej wykonywano laparoskopowe płukanie i drenaż przepływowy jamy otrzewnej. Z powodu pęknięcia wrzodu operowano doraźnie laparoskopowo 2,4% osób (59 pacjentów, średni wiek 42,7 roku). Ostatnia grupa to chorzy po urazach jamy brzusznej stanowiący 1,8% badanych (45 osób, średni wiek 38,5 roku), u których laparoskopię przeprowadzono pod warunkiem stabilności hemodynamicznej. Wyniki: Zgony w omawianej grupie chorych zanotowano jedynie w przypadkach ostrego zapalenia trzustki (27), perforacji wrzodu (2) oraz urazów jamy brzusznej (11). Wśród osób z ostrym zapaleniem pęcherzyka żółciowego oraz wyrostka robaczkowego nie obserwowano zgonów. Zastosowanie laparoskopii wiązało się z małą liczbą powikłań i krótką hospitalizacją. Podczas 3,1% cholecystektomii, 4,5% appendektomii oraz 21,3% operacji przedziurawionego wrzodu doszło do konwersji. Użycie laparoskopii pozwoliło na uniknięcie laparotomii u 44% pacjentów po urazie brzucha. Wniosek: Technika małoinwazyjna umożliwia uzyskanie bardzo dobrych wyników leczenia i może być szeroko stosowana u chorych z ostrymi chirurgicznymi chorobami jamy brzusznej.