Page 13 - WALS Journal

The Role of Laparoscopic Surgery in the Surgical Treatment of HIV Patients

taken whether to conserve or proceeded to surgery. Abscesses collected by reviews of articles laparoscopic surgeries on HIV
can be drained under direct vision. patients by using search engine Google, Highwire press,
Springerlink,PubMed,Yahoo & other linked references. The
Laparoscopy in Biliary Disorders keywords used are HIV, laparoscopy, universal precautions,
immunocompression and complications.
Commonest surgical presentation in HIV patients is acalculus
cholecystitis where open cholecystectomy is dangerous here SOURCE OF DATA
laparoscopy is the best option. Also conditions like obstructive
jaundice due to ca-pancreas laparoscopic Whipple’s operation Seventy-four patients of HIV operated for various surgical
can be done. presentations operated at BEL-AIR HOSPITAL, PANCHGANI,
MAHARASHTRA forms main source of data for present study.
Laparoscopy in Pulmonary Diseases Patients were presented to surgery OPD, referred from HIV wards
for surgical problem and from other medical practitioners after
Laparoscopy is also useful for diagnosis (thoracoscopy) and diagnosis of HIV.
different therapeutic procedures in HIV patients like closure of
bullies, pnuemonectomy, etc.
SELECTION OF PATIENTS
Laparoscopy for Lymph Node Biopsy The patients with surgical indication were selected as per their
presentation for either emergency or planned open surgeries.
This is most common indication for diagnosis of different For the routine surgeries patients were investigated for basic
conditions histopathologically, (e.g. cervical lymph nodes) and anesthesia point. HIV confirmatory test, CD4 count was
during this risk of needle prick injuries are more during open also done apart from above investigations. Preoperative single
surgery so laparoscopic approach is best for same. It is also dose of antibiotics were given almost every case.
useful for biopsy of mesenteric and pre- and para-aortic lymph
nodes avoiding major laparotomy.
OPERATIVE TECHNIQUE
Anal Disorders During surgery strict universal precautions were taken by whole
surgical team, like use of eye protective goggles, full rubber
This is the one of commonest surgical presentation in HIV shoes, plastic arm guards, foot cover, waterproof surgical
patients due to loss of perianal fat there develops piles and gowns, double gloves etc. Also precautions were taken to avoid
rectal prolapse which can be treated laparoscopically with spillage on floor, needle stick injuries were prevented by
minimum complications.
avoiding direct transfer of sharp instruments from surgeon to
nurse and vice versa, i.e. keeping a kidney tray between. All
CONTRAINDICATIONS FOR LAPAROSCOPY
waste materials were disposed as per CDC guidelines. As much
Contraindications for laparoscopy are same for both HIV positive as disposable items were used.
and negative patients. Postoperatively patients were transferred either to SICU or
1. Severe COPD and cardiac diseases wards as per patient’s condition. Usually patients were
2. Grade II and III shock discharged on 9th or 10th day after removal of sutures.
3. General peritonitis
4. Previous extensive abdominal surgery Post Exposure Prophylaxis (PEP)
5. Bleeding disorder Post exposure prophylaxis (PEP) is antiretroviral drug treatment
6. Advanced stages of pregnancy that is started immediately after someone is exposed to HIV.
7. Suspected malignancy The aim is to allow a person’s immune system a chance to
8. Patients with cryptococcal meningitis
provide protection against the virus and to prevent HIV from
becoming established in someone’s body. In order for PEP to
MATERIAL AND METHODS
have a chance of working the medication needs to be taken as
The source of data was open surgeries performed on HIV soon as possible and definitely within 72 hours of exposure to
patients at Bel-Air Hospital, Panchgani, during the period of HIV. Left any longer and it is thought that the effectiveness of
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November 2006 to December 2007. Bel-Air Hospital is one of the treatment is severely diminished PEP usually consists of
leading institute for HIV treatment and doctors training center a month long course of two or three different types of the
under Indian Red-Cross Society and NACO. The results of antiretroviral drugs that are also prescribed as treatment for
open surgeries are compared with the review articles data people with HIV. The commonest used regimen in our hospital

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