Page 11 - WALS Journal

The Role of Laparoscopic Surgery in the Surgical Treatment of HIV Patients
World Journal of Laparoscopic Surgery, May-August 2008;1(2):9-14
The Role of Laparoscopic Surgery in the

Surgical Treatment of HIV Patients

Vijaykumar Rajaram Naik
Consultant Laparoscopic Surgeon and GI Endoscopist, Bel-air Hospital, Panchgani, Dist- Satara, Maharashtra, India

AIMS OF STUDY REVIEW OF LITERATURE
The purpose of present study is to evaluate the role of A computerized Medline Search was conducted from 1966
laparoscopic surgery in the surgical treatment of HIV patients through the present and turned up only 10 papers concerning
(related or unrelated to HIV illness in whom requiring surgical HIV positivity and surgery, none of them being in transgendered
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intervention) by comparing results of open surgeries with the or transsexual individuals. In 1997, Flum and Wallack conducted
results of review articles on laparoscopic surgeries under a literature search concerning the impact of the human
following headings as: immunodeficiency virus infection and syndrome has had on
the practice of surgery. They concluded that the incidence of
1. Universal precautions during surgery
2. Procedure details human immunodeficiency virus infection ranges from 1.3% of
3. Operation time patients hospitalized at sentinel hospitals to 1.5/1,000 patients
4. Blood loss in lower risk environments. The rate of percutaneous injury
5. Occupational exposure risk during an operation is 5 to 6% and human immunodeficiency
6. Postoperative analgesics requirement virus transmission after percutaneous injury with a needle
7. Postoperative morbidity and mortality contaminated with the human immunodeficiency virus is 3%.
8. Economy Furthermore, Lowenfels, Mehta, Levi, Montecalvo, Savino and
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Wormser reported in 1993 on the incidents of percutaneous
injuries in surgeons. They reported that there was a decrease in
INTRODUCTION
the frequency of reported percutaneous injuries over the period
Despite much clinical experience, there are few published 1988 to 1993. The number of yearly injuries per surgeon
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accounts of the surgical manifestations of HIV/AIDS and role decreased from 5.5 to 2.1. As Flum and Wallack reported, the
of laparoscopic surgery in HIV patients. More than 40 million transmission of human immunodeficiency virus after
people worldwide are infected with HIV. Surgical treatment of percutaneous injury with a needle contaminated with HIV is
HIV-infected patients is indicated for problems both related 3%. It would therefore seem not particularly dangerous to the
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and unrelated to HIV infection. The laparoscopic surgeon plays individual surgeon, providing universal precautions are
an important role in the diagnosis and management of AIDS undertaken, to undertake surgery on HIV positive patients. From
related conditions in conjunction with physician. As most of the first case in 1988 until mid 1995, our index of severity of HIV
the HIV patients are poorly nourished, immunocompromised infection was the CD4 Lymphocyte count. After this time the
and final outcome of the open surgeries is not satisfactory. viral load has been used and this is measured as viral RNA.
Laparoscopic procedures provide several specific advantages Before 1995, measurement of viral load was unavailable to us.
over routine (open) procedures in this population. For the patient, In 1901, first diagnostic laparoscopy was performed by Kelling
the extent of invasiveness is diminished; incisions are on dog. After him in 1910, a Swedish internist, Jacobaeusc
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limited, associated with better preservation of the immune performed first diagnostic laparoscopy in human. After that an
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system than open surgery which decreases healing time and era of minimal access surgery created outbreak in the treatment
wound complications, pulmonary function is optimized; and of HIV patients due its advantages over traditional open
the patient rapidly returns to regular activity. Although CO 2 surgeries.
pneumoperitoneum affects the peritoneal response to injury, it
seems to have no harmful effect in terms of intra-abdominal INDICATIONS OF LAPAROSCOPY IN HIV PATIENTS
infection. For the surgical team, risk of exposure to body fluids Indications of laparoscopy in surgical patients and HIV patients
is minimized. 5 are almost same as HIV- negative patients.

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