Acute abdomen is still difficult to diagnose clinically in atypical patients due to its diverse presentation and urgency of treatment. Laparoscopic diagnosis of acute abdomen has the advantages of minimal trauma, open intra-abdominal view, and comprehensive exploration, with a confirmation rate of 90% to 100%. The current consensus is that laparoscopy can be a diagnostic option when non-traumatic J know means are not diagnostic. In addition to diagnosis, the latest 2012 European Endoscopy Society (EAES) guidelines have recommended laparoscopic surgery as a priority in a variety of acute abdominal conditions, including acute cholecystitis, perforated peptic ulcer, appendicitis, and gynecologic disease, but controversy exists for those requiring more complex surgery such as cholangitis, incarcerated hernia, colonic obstruction, and small bowel obstruction. In recent years, the author has completed hundreds of cases of acute abdominal surgery, most of which, including grade III complex acute abdominal surgery, can be completed safely with laparoscopy with satisfactory results. According to the EAES consensus (2011), patients with acute cholecystitis should be operated early and laparoscopic surgery is preferred unless there is a contraindication to laparoscopic surgery. All 31 cases of acute cholecystitis in our group underwent laparoscopic cholecystectomy, and no one case was converted to open surgery, confirming the above point. II. Acute cholangitis Tokyo guidelines [31 recommend that PTC or ERCPHl be preferred. In our group of 18 cases of acute cholangitis, except for 1 case in which open surgery was chosen due to a history of multiple biliary procedures, 17 cases were laparoscopic common bile duct exploration without 1 case of intermediate surgery and 9 cases were intraoperative choledochoscopy. III. Incidental hernia (inguinal and diaphragmatic hernia) The SAGES consensus and EAES consensus of the American Society of Gastroenterology and Endoscopy concluded that the complication rate of laparoscopic surgery for diaphragmatic hernia incarceration is lower than that of open surgery. In our group, one case of retrosternal hernia, one case of esophageal hiatal hernia, and one case of acute ingrowth of a giant traumatic diaphragmatic hernia were successfully repositioned and repaired laparoscopically. For abdominal wall hernia, laparoscopic pneumoperitoneum pressure expansion of the hernia ring makes the hernia easier to retract, and at the same time can fully explore the abdominal cavity ∞ J. In our group, three cases of inguinal incarcerated hernia and one case of incisional hernia incarcerated by laparoscopic surgery since 2013 were successfully retracted and repaired, and satisfactory results can be achieved by using Johnson & Johnson PHS light flat patch repair. In the current SAGES and EAES consensus, acute colonic obstruction is not an indication for laparoscopic surgery, and its management is controversial.’6o Only secondary surgery after laparoscopic perforation and fistula has been reported. Transverse colostomy and transverse colectomy and fistula were performed in one case each with satisfactory results. It shows that laparoscopy can be competent for acute colonic obstruction if there are suitable cases. V. Small bowel obstruction The treatment of small bowel obstruction can be attempted with laparoscopic mo o. Our experience is that the use of non-invasive instruments and the exploration strategy starting from the hollow intestinal canal distal to the obstruction (e.g., ileocecal) can effectively avoid medically induced intestinal perforation. In addition, patients requiring intestinal resection and treatment of non-adherent small bowel obstruction (e.g., intussusception, tumor) can also be treated by making a small incision of 12-20 mm at an appropriate location after laparoscopic localization, pulling the hook to dilate and pulling out the diseased intestine, and easily completing extra-abdominal resection and anastomosis. The laparoscopy helps to locate the diagnosis and definite surgery, and the complication rate is reduced ∽J. Thorough flushing of the abdominal cavity is a difficult point in laparoscopic treatment. We use pressurized flushing device and position change to shorten flushing time and avoid residual fluid and abscess formation after surgery. However, for patients with long perforation time and severe contaminated adhesions, two cases in our group were selected for intermediate open surgery for more thorough cleaning and drainage of the abdominal cavity. VII. Appendicitis Although it has been reported that laparoscopic surgery increases the rate of residual abdominal infection, only 2 cases of laparoscopic appendectomy in this group of 67 cases showed early learning curve of residual abdominal infection, and all of them improved with conservative treatment. Changing the position, aspiration of local pus before separation and resection, local flushing and thorough aspiration after resection are effective measures to avoid postoperative infection.