Clinical surgery-InternationalLaparoscopic diagnosis and treatment of postoperative complications
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.
References (20)
- et al.
Relaparoscopy for the detection and treatment of complications of laparoscopic cholecystectomy
Am J Surg
(2000) - et al.
Role of diagnostic laparoscopy in diagnosis and management of postoperative complications of gastric by-pass patients (abstrt)
Surg Obes Relat Dis
(2005) - et al.
Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery
Surg Endosc
(2006) - et al.
The laparoscopic second look for ischemic bowel disease
Surg Endosc
(1996) - et al.
Laparoscopic management of complications following laparoscopic cholecystectomy
Aust N Z J Surg
(1994) - et al.
Role of relaparoscopy in the management of minor bile leakage after laparoscopic cholecystectomy
Br J Surg
(2000) - et al.
Duodenal perforations after laparoscopic cholecystectomy
Surg Endosc
(1999) - et al.
Laparoscopic management of surgical complications after a recent laparotomy
Surg Endosc
(2004) - et al.
The efficacy of laparoscopic surgery in the diagnosis and treatment of peritonitisExperience with 107 cases in Mexico City
Surg Endosc
(1997) - et al.
The use of laparoscopy in abdominal emergencies
Surg Endosc
(2003)
Cited by (20)
A systematic review of the role of re-laparoscopy in the management of complications following laparoscopic colorectal surgery
2016, SurgeonCitation Excerpt :Unstable patients in the postoperative setting require resuscitation followed by laparotomy irrespective of the initial operative approach. However several studies have reported that in selected patients who have developed complications following laparoscopic colorectal surgery, they can be safely managed by re-laparoscopy and as a consequence, there is a growing trend towards this approach.33–45 Increased familiarity with laparoscopic techniques, in addition to improvements in technology, have also played a role in this trend.
Re-laparoscopy in the diagnosis and treatment of postoperative complications following laparoscopic colorectal surgery
2013, SurgeonCitation Excerpt :Despite this, there is little in the literature regarding the role of re-laparoscopy in the diagnosis and management of complications following laparoscopic colorectal surgery.14 There are however 2 series by Kirshtein et al. which describe the role of re-laparoscopy following other intra-abdominal procedures such as appendicectomy, cholecystectomy and adhesiolysis.15,16 Wszolek et al. report their experience of laparoscopy in the detection and management of complications following minimally invasive urologic surgery.17