Laparoscopy and Laparotomy of Complications Acute Intestinal Obstruction (AIO) Treatment

 

Laparoscopic Trainer

Laparoscopic Trainer

Laparoscopy Management of Complications

Most surgeons believe that laparoscopy is effective and safe in the management of complications after laparoscopic and endoscopic procedures, although it is not easy to perform. Laparoscopic access, while maintaining the integrity of the abdominal wall, allows you to directly visualize the abdominal cavity, quickly identify the complication and choose the necessary tactics.

The use of Laparoscopic Trainer is a prudent choice for Training.

Moreover, laparoscopy reduces the number of complications after reoperation, mortality, length of hospital stay, improves quality of life, reduces pain and ensures a quick return of the patient to normal activities.

Peritonitis Study

78 cases of peritonitis were observed, which the authors treated laparoscopically. In 42 cases, anastomotic leakage observes after colorectal surgery (26 - anterior resection of the rectum, 9 - left-sided hemicolectomy, 7 - right-sided, the overall rate of anastomotic leakage was 3.2%). Reoperation consisted of abdominal lavage, placement of one or more drains, ileostomy (38 cases, 90.5%) or Hartmann's operation (4 cases, 9.5%).

24 patients had colon perforation: 2 after laparoscopic left-sided nephrectomy, 18 after colonoscopy and 4 due to intestinal ischemia after left-sided hemicolectomy. With ischemic perforation, the Hartman operation performs. Endoscopic perforation was eliminated by direct suturing on a well-prepared intestine - in early operations and minor injuries (n=9); in other cases, sutures were supplemented with ileostomy (n=8). One case of perforation during endoscopic polypectomy ended with resection with primary anastomosis.

Colon perforation after nephrectomy treats with following:

·         Abdominal lavage,

·         Exteriorization of the damaged intestine, and

·         Temporary colostomy,

·         Followed by its closure after 2 months

Clinical Manifestations

The authors observed 2 cases of small bowel perforation after left-sided hemicolectomy due to incorrect traction with a clamp that went beyond the field of view. Clinical manifestations are peritonitis on the second day after surgery. It is Conducted suturing interrupted sutures, washing and drainage of the abdominal cavity.

Observed 1 case of jejunal perforation after laparoscopic suturing of a large ventral hernia in the right upper quadrant of the abdomen in a complete patient. Perforation detects on the second day after the receipt of intestinal contents through the Redon drainage. It was probably a delayed perforation due to thermal damage to the visceral peritoneum of the intestine after the restoration of peristalsis. The abdominal cavity washes, the defect sutures, the mesh abundantly wash (ultralight, macroporous) and drainage left. The postoperative course was favorable with discharge on the 6th day. Neither mesh infection nor recurrence observes for 2 years.

Operates Laparoscopically and Laparotomy

The authors operated on 7 cases of biliary peritonitis after LCE. Two bile leaks from the accessory duct of the gallbladder bed, the duct sutures with 4-0 sutures, and the space drains. In 4 cases, the source of bile leakage was not found: in 3 cases, the abdominal cavity was washed and papillosphincterotomy (PST) was performed. In 1 patient, an accessory duct of the IV segment of the liver was found. He underwent PST with the installation of a biliary stent.

In 11 patients, duodenal perforation observes after endoscopic PST. Only the first patient treats laparoscopically. The course was unfavorable and the patient died of sepsis on the 16th day. The second case operates laparoscopically, but switches to laparotomy due to technical difficulties. These episodes convinced the authors that these complications should operates on by laparotomy due to the need for extensive mobilization of the duodenum. In 4 cases, perforation was detected after the introduction of bluing through the probe, followed by suturing, omentopexy, cholecystectomy and installation of a T-shaped drainage. In the remaining 6 cases, the perforation was not found, limited to drainage of the abdominal cavity.

Postoperative Acute Intestinal Obstruction (AIO)

Of the 25 cases, all patients cure laparoscopically, except for one. The most common cause of Acute intestinal obstruction (AIO) is early postoperative adhesive obstruction in 14 cases: in 2 patients, adhesions occurred between the mesh and the intestine after ventral hernia repair; 2 - resection of the small intestine, 1 - ventral hernioplasty). 13 patients underwent laparoscopic adhesiolysis. In 1 case, bowel resection was required due to ischemia.

The procedure successfully completes in 158 (98.7%) patients. The postoperative bed-day was longer with generalized peritonitis than and bleeding. The total number of complications after reoperation was 7.5% (12/160). Adverse events included 4 cases of sub-diaphragmatic abscess treated with CT-guided percutaneous puncture, 4 cases of pulmonary insufficiency due to bronchopneumonia with effusion pleurisy treated with medication, 2 cases of pulmonary embolism treated conservatively, 2 cases of heart failure also treated with medication.

Mortality was 1.87%. 3 patients died: 1 from myocardial infarction on the 15th day after the operation, 1 from pulmonary embolism on the 10th day after the operation, and the third from sepsis on the 18th day.

Endo-Surgery Treatment

In urgent surgery, DL becomes the method of choice when minimally invasive diagnostic methods are ineffective or give an uncertain result, since laparoscopy provides direct and optimal visualization of the abdominal organs. In many cases, endo-surgery allows for radical treatment with minimal trauma, avoiding abdominal surgery.

In a series of 55 patients with acute abdomens, demonstrate the diagnostic value of laparoscopy is equal to that of laparotomy. Reported laparoscopy provides a correct diagnosis in 98.6% of patients with acute abdomen. Many authors report a diagnostic benefit of laparoscopy of 89–100%. In 80% of cases, acute abdomens can treats laparoscopically. Abdominal emergencies are often a challenge for the surgeon, since many diseases can have a similar clinical picture, and accurate diagnosis and adequate treatment become key. In the case of peritonitis, laparoscopy provides a complete examination of the abdominal cavity with good sanitation of the abdominal cavities.

Peritonitis Contraindication

However, today some authors consider peritonitis a contraindication to laparoscopy, since it increases the risk of bacteremia and endotoxemia, which can causes by PN. Although other experts believe that laparoscopy is safe and effective in this situation.

Conclusion

Laparoscopy is constantly evolving and becoming the gold standard in the treatment of many human diseases. Thanks to the improvement of technology, the growth of the skill of surgeons and the spread of highly specialized centers, laparoscopy is gaining importance not only in elective, but also in emergency surgery.

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