Page 12 - WALS Journal

Vijaykumar Rajaram Naik

Laparoscopy in HIV Positive Patients with Acute Role of Laparoscopy in Gynecological Emergencies
Abdomen
Laparoscopy is useful in the early recognition of pelvic
• Correct diagnosis achieved with least surgical trauma. inflammatory disease and Fitz Hughes Curtis syndrome
• Institution of timely and effective treatment. (Perihepatitis associated with PID). It is also useful in the early
• Reduction of risks of transmission of virus to theater recognition of pelvic inflammatory disease and Fitz Hughes
personnel’s due to small incision and less contact with Curtis syndrome (Perihepatitis associated with PID).
patient’s body fluids.
Role of Laparoscopy in Suspected Acute Appendicitis
Diagnostic laparoscopy minimizes unnecessary laparotomies
and complications. Commonest abdominal emergency all round the world is acute
appendicitis. An early diagnostic laparoscopy in suspected
Laparoscopy in Trauma Patients (Blunt and acute appendicitis reduces the risk of appendiceal perforation,
Penetrating) improves diagnostic accuracy and reduces the number of
negative laparotomies. It helps the surgeon to rule out
Trauma patients with equivocal signs are always a dilemma, concomitant problems but two important groups of patients
more so when patients are victims of “Urban violence, car where it is immensely useful in:
accidents, intoxication by alcohol, spinal cord injury and/or
head injury. Commonly used diagnostic peritoneal lavage (DPL) • Premenopausal women when it is difficult to rule out
has a sensitivity of > 95% and specificity of 83%. The rate of • gynecological conditions.
Obese patients in whom large incisions may be required to
unnecessary laparotomy is still very high with a morbidity of remove the appendix.
20% and mortality of 6%. If diagnostic laparoscopy is combined
with diagnostic peritoneal lavage then the sensitivity can be Laparoscopy in Patients with Perforated Peptic
increased up to 100% and specificity up to 90%. Diagnostic Ulcers
laparoscopy is extremely useful in patients with equivocal signs
and hemodynamically stable. It is slowly replacing the old belief Early diagnosis and treatment of perforated peptic ulcer within 6
that, all penetrating abdominal wounds whether stab or gunshot hours of the incident can reduce mortality from 90% to about
should be explored. Also in cases of subcapsular tears of liver 10%. Diagnostic laparoscopy is much more sensitive than CT as
or spleen or minor tears in mesentery or omental injury can now it can determine the type of fluid along with food debris and can
be completely conserved saving the number of non-therapeutic accurately localize the site of perforation. Perforations are closed
laparotomies (NTL). by simple suture, omental patch, fibrinous glue, falciform ligament
patch or ligamentum teres patch. The trend is towards suture
less closure or ligamentous patches. A larger delay, beyond 6
Laparoscopy in ICU Patients/Critically Ill
hours, makes closure difficult and hazardous due to inflammatory
• Acalculus/Calculus cholecystitis. changes and phlegmon. Main disadvantage is increased
• Large bowel perforation. operating time and recent studies have not shown to decrease
• Duodenal and gastric perforations (e.g. stress ulcers) length of hospital stay, resumption of normal diet, reduction of
• Duodenal and gastric perforations (e.g. stress ulcers) pain in the first 24 hours, or early return to normal activities.
• Pancreatitis (due to biliary sludge) Prospective random trials are needed to clarify these factors.
• Intra-abdominal hemorrhage.
Laparoscopy and Small Bowel Obstruction (SBO)
It is extremely difficult to diagnose above mentioned
complications in a patient who is already in MOF (multiple organ Early SBO, with minimal peritonitis, single band adhesions,
failure). There are no symptoms and signs which can be elucidated without obvious gangrenous changes in the bowel can be
as patients are on ventilation or gravely ill and delay in surgical managed by therapeutic laparoscopy.
treatment may lead to increase in morbidity and mortality. The other criteria for selection are:
• Proximal obstruction.
Laparoscopy in Chronic Abdomen in HIV Patients • A partial obstruction.
• Obstruction partially responding to nasogastric suction.
Most of patients presenting with chronic abdominal pain after
laparotomy found to have mesenteric lamphadenopathy, or drug Laparoscopy and Diverticular Disease
induced pancreatitis, here diagnostic laparoscopy can take
mesenteric lymph node biopsy without much major surgical Diagnostic laparoscopy is very useful in diagnosing severity
trauma. of diverticular disease so that management decision can be

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