Clinical surgery-International
Laparoscopic diagnosis and treatment of postoperative complications

https://doi.org/10.1016/j.amjsurg.2007.10.019Get rights and content

Abstract

Background

There is no unequivocal attitude to a laparoscopy as to the means in the diagnosis and treatment of postoperative surgical complications. Our study sought to determine the role of laparoscopy in the management of suspected postoperative complications.

Methods

We performed a retrospective review of the patients who underwent laparoscopy for complications of previous surgery over a 6-year period.

Results

Sixty-four patients underwent laparoscopy for complications during the study period including 49 laparoscopies, 14 laparotomies, and 1 endoscopic procedure. The median delay between operations was 2 ± 4.5 days. In 18 (28.1%) patients, laparoscopy did not find intra-abdominal pathology. The conversion to open surgery was necessary in 9 (14.1%) patients. Seven patients underwent more than 1 relaparoscopy. No cases of misdiagnosis were observed. Morbidity was 12.5%. There was no laparoscopy-related death.

Conclusions

Laparoscopy is an effective tool for the management of postoperative complications after open and laparoscopic surgery. It avoids diagnostic delay and unnecessary laparotomy.

Section snippets

Materials and Methods

A retrospective analysis of 64 consecutive patients who required laparoscopy for postoperative complications between January 2000 and December 2005 was performed. Patients were identified by a search of the operating room database. Data were collected from hospital charts and operative reports. Demographic and clinical variables included age, sex, American Society of Anesthesiologists score, type of primary surgery and its complications, indications for repeated operations, time between

Technique

In cases of initial laparoscopy, intra-abdominal reentrance was obtained through the previous port sites. Pneumoperitoneum was achieved through an 11-mm trocar cannula inserted blindly, usually periumbilically. Other trocars were inserted under direct vision. According to surgeon preference, Veress needle or Hassan technique were used for abdominal insufflation in patients with a previous laparotomy performed as far as possible from the previous laparotomy wound, usually in the left subcostal

Results

Sixty-four patients underwent laparoscopy for suspected complications of previous surgery. Patients' data are presented in Table 1. Fifty-one (80%) patients underwent laparoscopy during the first 76 hours after initial surgery. Abdominal plain film was performed in 5 patients with suspected early postoperative small bowel obstruction. A chest x-ray was done to recognize suspected intra-abdominal free air. An abdominal computed tomography scan was negative in 4 patients and revealed

Comments

Re-exploration for complications of abdominal surgery is required in 1.7% of patients.11 The presence of marked abdominal pain, tenderness, guarding, or early wound infection may be suspect for postoperative complication. Usually, these patients were undergoing surgical re-explorations (relaparotomy for diagnosis and treatment of complications). Laparoscopy was found to be clearly superior for patients with a presumable diagnosis of perforated peptic ulcer, acute cholecystitis, appendicitis, or

Conclusion

Laparoscopy is an effective tool for the management of postoperative complications after open and laparoscopic surgery. It is feasible, safe, and avoids diagnostic delay and unnecessary laparotomy.

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