Early laparoscopy versus active observation in acute abdominal pain: Systematic review and meta-analysis

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Abstract
Patients with acute abdominal pain account for half of acute general surgical admissions. About one-third have no clear diagnosis at the time of presentation. Traditionally, such patients were managed by active observation and repeated clinical assessment over a period of time. More recently, the use of early laparoscopy has been advocated. The Medline and PubMed databases, trial registries and conference proceedings were searched to identify randomised controlled trials comparing early laparoscopy to active observation in patients with undifferentiated acute abdominal pain. The systematic review identified four eligible trials (811 patients). Early laparoscopy reduced the number of patients discharged without a final diagnosis (pooled odds ratio: 0.13; 95% CI: 0.03-0.51; p=0.003). There were no statistically significant effects on complications, readmission rates or hospital stay. There was evidence of significant heterogeneity between the trials. There is insufficient evidence to recommend routine use of early laparoscopy as the gold standard in patients with undifferentiated acute abdominal pain. Conversely, there is no evidence of harm. Further large clinical trials are required to determine the role of laparoscopy in this clinical situation.