ISSN 1694-8882 / e-ISSN 1694-8890
Vol. 18, No. 1, 2026 / Pages 15-49

Current trends and evidence in minimally invasive emergency abdominal surgery: A systematic review of the literature (literature review)

chapyev75@mail.ru

Received 21.08.2025
Revised 10.12.2025
Accepted 27.02.2026

Abstract

Emergency abdominal surgery is one of the most rapidly evolving fields of medicine, marked by the active adoption of minimally invasive technologies. Yet the strength of evidence supporting their use across different conditions remains uneven – necessitating systematisation and critical reappraisal of accumulated data, with attention to publications from 2000 to 2025. The aim was to systematise and critically evaluate the evidence from 2000 to 2025 concerning the use of minimally invasive technologies in the most common urgent abdominal conditions, and to identify promising directions for further research. A systematic literature search was conducted in the PubMed, Cochrane Library, Scopus and Web of Science databases for the period 2000-2025. Inclusion criteria covered systematic reviews, meta-analyses and randomised controlled trials. Forty-four sources were included in the analysis. For acute cholecystitis, meta-analyses demonstrated the advantages of early cholecystectomy, reducing hospital stay from 17.8 to 9.6 days with comparable mortality rates. Robot-assisted cholecystectomy reduces the conversion risk by 34% compared with conventional laparoscopy. Ultrasonic dissection shortens operating time by 9 minutes and reduces blood loss by 28 mL. For perforated ulcers, endoscopic techniques reduce respiratory complications by a factor of 2.4, though the methodological quality of the studies remains insufficient. In acute pancreatitis, an endoscopic step-up approach using lumen-apposing metal stents shows the best clinical outcomes. For adhesive small bowel obstruction, five-year follow-up studies found no long-term advantage for laparoscopy. For acute appendicitis, laparoscopic access reduces wound complications by a factor of 2.4, with comparable rates of intra-abdominal abscesses. These findings can help optimise surgical strategy in urgent abdominal conditions, informed by current evidence

Keywords

minimally invasive procedures; laparoscopy; robotic surgery; evidence-based medicine; meta-analysis

Suggested citation

APA Style
Chapyev, M., Mamakeev, K., Kurmanov, R. & Tilekov, E. (2026). Current trends and evidence in minimally invasive emergency abdominal surgery: A systematic review of the literature (literature review). Eurasian Health Journal, 18(1), 15-49. https://doi.org/10.54890/1694-8882-2026-1-15
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Vancouver Style
Chapyev, M., Mamakeev, K., Kurmanov, R., Tilekov, E.. Current trends and evidence in minimally invasive emergency abdominal surgery: A systematic review of the literature (literature review). Eurasian Health J. 2026;18(1):15-49. https://doi.org/10.54890/1694-8882-2026-1-15
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References

  1. Pisano M, Allievi N, Gurusamy K, Borzellino G, Cimbanassi S, Boerna D, et al. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg. 2020;15:61. DOI: 10.1186/s13017-020-00336-x
  2. Camarotti TAF, Lenzi MC, Cardoso JHCO, de Oliveira TTC, Vieira TAI, de Carvalho MCAP, et al. Clinical outcomes of robotic-assisted versus laparoscopic cholecystectomy in nonelective procedures: A systematic review and meta-analysis. J Trauma Acute Care Surg. 2025;100(4):652–9. DOI: 10.1097/TA.0000000000004851
  3. Moqbel I, Albashier M, Tawadros MM, Helal MB, Abdelbaset AH, Abdelmeguid AI, et al. Safety and efficacy of ultrasonic dissection versus electrocautery dissection in laparoscopic cholecystectomy for acute cholecystitis: An updated systematic review and meta-analysis. Surg Endosc. 2025;39(10):6366–82. DOI: 10.1007/s00464-025-12132-2
  4. Abdallah HS, Sedky MH, Sedky ZH. The difficult laparoscopic cholecystectomy: A narrative review. BMC Surg. 2025;25(1):156. DOI: 10.1186/s12893-025-02847-3
  5. Nadeem A, Husnain A, Ahmed A, Ashfaq H, Ashraf H, Nadeem ZA, et al. Percutaneous cholecystolithotomy and lithotripsy for managing acute calculous cholecystitis in non-surgical candidates: A systematic review and meta-analysis. Clin Endosc. 2025;58(5):684–95. DOI: 10.5946/ce.2024.256
  6. Mukai S, Sofuni A, Tsuchiya T, Tanaka R, Tonozuka R, Matsunami Y, et al. Endoscopic step-up approach for walled-off necrosis after acute pancreatitis. DEN Open. 2025;6(1):e70188. DOI: 10.1002/deo2.70188
  7. Papi C, Catarci M, D’Ambrosio L, Gili L, Koch M, Grassi GB, et al. Timing of cholecystectomy for acute calculous cholecystitis: A meta-analysis. Am J Gastroenterol. 2004;99(1):147–55. DOI: 10.1046/j.1572-0241.2003.04002.x
  8. Lau H, Lo CY, Patil NG, Yuen WK. Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: A metaanalysis. Surg Endosc. 2006;20(1):82–7. DOI: 10.1007/s00464-005-0100-2
  9. Gurusamy KS, Davidson C, Gluud C, Davidson BR. Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis. Cochrane Database Syst Rev. 2013;6:CD005440. DOI: 10.1002/14651858.CD005440.pub3
  10. Roulin D, Saadi A, Di Mare L, Demartines N, Halkic N. Early versus delayed cholecystectomy for acute cholecystitis, are the 72 hours still the rule? A randomized trial. Ann Surg. 2016;264(5):717–22. DOI: 10.1097/SLA.0000000000001886
  11. Gutt CN, Encke J, Köninger J, Harnoss JC, Weigand K, Kipfmüller K, et al. Acute cholecystitis: Early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study). Ann Surg. 2013;258(3):385–93. DOI: 10.1097/SLA.0b013e3182a1599b
  12. Woldehana NA, Jung A, Parker BC, Coker AM, Haut ER, Adrales GL. Clinical outcomes of laparoscopic vs robotic-assisted cholecystectomy in acute care surgery. JAMA Surg. 2025;160(7):755–62. DOI: 10.1001/jamasurg.2025.1291
  13. Coco D, Leanza S. Robotic-assisted surgery for acute abdominal emergencies: A systematic review of 1142 cases. J Robot Surg. 2025;19(1):558. DOI: 10.1007/s11701-025-02657-y
  14. Qadri M, Habib E, Ghawas AA, Aftab M, Jamshed A, Adnan M, et al. Clinical outcomes of laparoscopic versus robotic cholecystectomy approaches: A systematic review and GRADE assessment meta-analysis. J Robot Surg. 2025;20:61. DOI: 10.1007/s11701-025-03022-9
  15. Di Martino M, Gancedo Quintana Á, Vaello Jodra V, Sanjuanbenito Dehesa A, Morales García D, Caiña Ruiz R, et al. Early laparoscopic cholecystectomy in oldest-old patients: A propensity score matched analysis of a nationwide registry. Updates Surg. 2022;74(3):979–89. DOI: 10.1007/s13304-022-01254-0
  16. Dumitrascu I, Zarnescu NO, Zarnescu EC, Pahomeanu MR, Constantinescu A, Minca DG, et al. Acute necrotizing pancreatitis-advances and challenges in management for optimal clinical outcomes. Medicina (Kaunas). 2025;61(7):1186. DOI: 10.3390/medicina61071186
  17. van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010;362(16):1491–502. DOI: 10.1056/NEJMoa0908821
  18. Bakker OJ, van Santvoort HC, van Brunschot S, Geskus RB, Besselink MG, Bollen TL, et al. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: A randomized trial. JAMA. 2012;307(10):1053–61. DOI: 10.1001/jama.2012.276
  19. Boxhoorn L, van Dijk SM, van Grinsven J, Verdonk RC, Boermeester MA, Bollen TL, et al. Immediate versus postponed intervention for infected necrotizing pancreatitis. N Engl J Med. 2021;385(15):1372–81. DOI: 10.1056/NEJMoa2100826
  20. Onnekink AM, Boxhoorn L, Timmerhuis HC, Bac ST, Besselink MG, Boermeester MA, et al. Endoscopic versus surgical step-up approach for infected necrotizing pancreatitis (ExTENSION): Long-term follow-up of a randomized trial. Gastroenterology. 2022;163(3):712–22. DOI: 10.1053/j.gastro.2022.05.015
  21. Baron TH, DiMaio CJ, Wang AY, Morgan KA. American Gastroenterological Association clinical practice update on management of pancreatic necrosis: Expert review. Gastroenterology. 2020;158(1):67–75. DOI: 10.1053/j.gastro.2019.07.064
  22. van Grinsven J, van Santvoort HC, Boermeester MA, Dejong CH, van Eijck CH, Fockens P, et al. Timing of catheter drainage in infected necrotizing pancreatitis. Nat Rev Gastroenterol Hepatol. 2016;13:306–12. DOI: 10.1038/nrgastro.2016.23
  23. Chalmers KA, Lee MJ, Cousins SE, Peckham Cooper A, Coe PO, Blencowe NS. Laparoscopic versus open repair of perforated peptic ulcer: Systematic scoping review and in-depth evaluation of existing evidence. BJS Open. 2025;9(2):zrae163. DOI: 10.1093/bjsopen/zrae163
  24. Sokhal BS, Mohamedahmed A, Zaman S, Wuheb AA, Abdalla HE, Husain N, et al. Laparoscopic versus open repair for peptic ulcer perforation: A systematic review, meta-analysis and trial sequential analysis of randomised controlled trials. Time to conclude! Ann R Coll Surg Engl. 2025;107(5):331–45. DOI: 10.1308/rcsann.2024.0082
  25. Panin SI, Nechay TV, Sazhin IV, Melnikov-Makarchuk KY, Sazhin AV, Puzikova AV, et al. Laparoscopic suture repair for perforated peptic ulcer disease: A meta-review and trial sequential analysis. Front Surg. 2025;12:1506484. DOI: 10.3389/fsurg.2025.1496192
  26. Räty P, Mentula P, Haukijärvi E, Juusela R, Wikström H, Koivukangas V, et al. Long-term outcomes after laparoscopic vs open adhesiolysis for small bowel obstruction: The LASSO randomized clinical trial. JAMA Surg. 2026;161(3):e256726. DOI: 10.1001/jamasurg.2025.6726
  27. Darbyshire AR, Kostakis I, Pucher PH, Toh SKC, Mercer SJ. The impact of laparoscopy on emergency surgery for adhesional small bowel obstruction: Prospective single centre cohort study. Ann R Coll Surg Engl. 2021;103(4):255–62. DOI: 10.1308/rcsann.2020.7079
  28. Sajid MS, Khawaja AH, Sains P, Singh KK, Baig MK. A systematic review comparing laparoscopic vs open adhesiolysis in patients with adhesional small bowel obstruction. Am J Surg. 2016;212(1):138–50. DOI: 10.1016/j.amjsurg.2016.01.030
  29. ten Broek RPG, Issa Y, van Santbrink EJP, Bouvy ND, Kruitwagen RFPM, Jeekel J, et al. Burden of adhesions in abdominal and pelvic surgery: Systematic review and meta-analysis. BMJ. 2013;347:f5588. DOI: 10.1136/bmj.f5588
  30. Al Abbood F, Altamimi O, Altamimi I, Alqur M, Alkhars F, Aljubran H, et al. Early surgery or conservative management for adhesive small bowel obstruction: A comprehensive systematic review of short- and long-term outcomes. Cureus. 2026;18(1):e101184. DOI: 10.7759/cureus.101184
  31. Wiggins T, Markar SR, Harris A. Laparoscopic adhesiolysis for acute small bowel obstruction: Systematic review and pooled analysis. Surg Endosc. 2015;29(12):3432–42. DOI: 10.1007/s00464-015-4114-0
  32. Khadwardi FH, Alfaifi AA, Alhevdey AZ, Alhevdey BZ, Elsayed RIRA, Abdalwahab HI, et al. A systemic review comparing laparoscopic versus open appendectomy. Rev Diabet Stud. 2025;21(2):45–58. DOI: 10.70082/ed1fyp58
  33. Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2010;10:CD001546. DOI: 10.1002/14651858.CD001546.pub3
  34. Jaschinski T, Mosch C, Eikermann M, Neugebauer EA. Laparoscopic versus open appendectomy in patients with suspected appendicitis: A systematic review of meta-analyses of randomised controlled trials. BMC Gastroenterol. 2015;15:48. DOI: 10.1186/s12876-015-0277-3
  35. Pata F, Nardo B, Ielpo B, Di Martino M, Murzi V, Di Saverio S, et al. Endoscopic retrograde appendicitis therapy versus appendectomy or antibiotics in the modern approach to uncomplicated acute appendicitis: A systematic review and meta-analysis. Surgery. 2023;174(6):1292–301. DOI: 10.1016/j.surg.2023.08.029
  36. Athanasiou C, Lockwood S, Markides GA. Systematic review and meta-analysis of laparoscopic versus open appendicectomy in adults with complicated appendicitis: An update of the literature. World J Surg. 2017;41(12):3083–99. DOI: 10.1007/s00268-017-4123-3
  37. Kossenas K, Kouzeiha R, Moutzouri O, Georgopoulos F. Single-incision versus conventional laparoscopic appendectomy in adults: A systematic review and meta-analysis of randomized controlled trials. Updates Surg. 2025;77(2):287–96. DOI: 10.1007/s13304-025-02112-5
  38. Sartelli M, Coccolini F, Kluger Y, Agastra E, Abu-Zidan FM, Abbas AES, et al. WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections. World J Emerg Surg. 2021;16(1):49. DOI: 10.1186/s13017-021-00387-8
  39. Coutureau J, Millet I, Taourel P. CT of acute abdomen in the elderly. Insights Imaging. 2025;16:95. DOI: 10.1186/s13244-025-01955-1
  40. Harji DP, Griffiths B, Stocken D, Pearse R, Blazeby J, Brown JM. Protocolized care pathways in emergency general surgery: A systematic review and meta-analysis. Br J Surg. 2024;111(3):znae057. DOI: 10.1093/bjs/znae057
  41. García-Sánchez FJ, Roque-Rojas F, Mudarra-García N. From emergency department to operating room. the role of early prehabilitation and perioperative care in emergency laparotomy: A scoping review and practical proposal. J Clin Med. 2025;14(19):6922. DOI: 10.3390/jcm14196922
  42. Mac Curtain BM, O’Malley S, Brennan K, Liddy R, O’Donoghue GT, Reynolds JV. Enhanced recovery after surgery protocols and emergency surgery: A systematic review and meta-analysis of randomized controlled trials. ANZ J Surg. 2023;93(7–8):1780–6. DOI: 10.1111/ans.18550
  43. Boonstra K, Voermans RP, van Wanrooij RLJ. Management of iatrogenic perforations during endoscopic interventions in the hepato-pancreatico-biliary tract. Best Pract Res Clin Gastroenterol. 2024;70:101890. DOI: 10.1016/j.bpg.2024.101890
  44. Williams RF, Grewal H, Jamshidi R, Naik-Mathuria B, Price M, Russell RT, et al. Updated APSA guidelines for the management of blunt liver and spleen injuries. J Pediatr Surg. 2023;58(8):1411–8. DOI: 10.1016/j.jpedsurg.2023.03.012