Laparoscopic emergency surgery in Korea: a comprehensive analysis of current practices

Laparoscopic surgery was a groundbreaking discovery in the history of surgery and is a form of minimally invasive surgery [1]. Laparoscopic surgery has many advantages over open surgery, such as a smaller incision, less pain, and faster recovery. Therefore, laparoscopic surgery is the first choice for elective surgery in many fields [2]. In emergency surgery cases, laparoscopic surgery is suggested with a high grade of recommendation for appendectomy, cholecystectomy, and perforated gastroduodenal ulcers [3]. However, there is not much evidence recommending laparoscopic surgery for the small bowel, colon, and pancreas. When performing emergency surgery for conditions due to injuries to the organs mentioned above, there is a higher possibility of hemodynamically unstable patient conditions or technical difficulty in laparoscopic surgery. However, as surgeons are gradually becoming more proficient in laparoscopic surgery and most hospitals are equipped with laparoscopic instruments, the proportion of laparoscopic surgery in emergency surgeries will increase further [4]. There has been no nationwide study on laparoscopic emergency surgery (LES) and open emergency surgery (OES) in Korea [4]. Examining and evaluating the current status is very necessary.

The article by Bae et al., published in the Journal of Minimally Invasive Surgery, examined the current status of LES and OES in Korea at a multicenter level. According to their results, the Charlson comorbidity index, emergency surgery acuity score, shock, and sepsis affected the choice of LES. Most appendectomies and cholecystectomies were performed laparoscopically, with rates of 93.7% and 88.0%, respectively, which are similar to those in the United States [4]. The OES rates for the small bowel, stomach, and large bowel were higher than those for LES, indicating that the surgery was more complicated, and the patient conditions were worse. When comparing Korea’s data with the literature, the small bowel LES rate was similar (10.6% vs. 6%–10%), the gastric LES rate was lower than expected (8.0% vs. 14%–30%), and the colorectal LES rate was higher (20.9% vs. 6%–12%) [4]. This was a retrospective study, and the surgeon’s preference may have affected the results significantly, leading to selection bias. Despite these limitations, this was a multicenter study involving a large number of patients. Due to the nature of emergency surgery, it may not be easy to plan a prospective study. However, by addressing the limitations mentioned in this study, further research is needed to determine why there are differences in LES rates compared to other countries.