Page 15 - WALS Journal

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

of postoperative complications during open surgeries was 25% The disadvantages of laparoscopy include the expensive
as compared to laparoscopic surgeries. 2,4,10,26-28 Also equipment involved in performing it. Not all hospitals may be
respiratory complication rate is also to the higher side as able to afford certain procedures.
compared to laparoscopic surgeries, 2,6,9-12,25,29 this is due to Another issue is the need for surgeons to take special
most of the patients are suffering from pulmonary TB, also due training in performing the minimally invasive operations. The
to poor built and weakness the ambulation is problem as need for additional training is because laparoscopic surgeons
compared to laparoscopy surgery maintains interior milieu. 7,30,31 leave the familiar territory of a three-dimensional operating field
The blood loss during major surgeries was ranged from to working on a two-dimensional flat video display. Learning
30 to 300 ml; it is very much towards higher side as compared to the procedures requires some degree of practice moving the
literatures on laparoscopic surgery. 6,13,18 This is because long laparoscopic instruments while handling delicate tissues.
laparoscopy is an electrosurgery and there is minimal tissue Finally, laparoscopy cannot always be performed on
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dissection and trauma. Postoperative analgesics requirements everyone. For example, some patients with many prior
were higher side as compared to laparoscopic surgery. The operations may have so much scar tissue within the body that
incidence of needle prick injuries during open surgery was found a safe laparoscopic operation cannot be done.
to be 7.6% is quite a higher than comparative to the standard Thus, in modern era of minimal access surgery laparoscopy
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rate, i.e. 0.3 %. The results of laparoscopic surgeries shown is an asset to the HIV patients by reducing mobility and
negligible risk of occupational transmission. This is because in increasing their life expectancy.
laparoscopy there is no direct exposure to the blood and
secretions, also suturing is done via small wound, also no much REFERENCES
sharp instruments used routinely. 5,23
The average operative time was 3 hours for major surgery 1. Flum DR, Wallack MK. The surgeon’s database for AIDS: a
and 30 minutes for minor surgery. Literature study showed collective review. Journal of the American College of Surgeons
laparoscopic surgeries are taking more time than open 1997;184(4):403-12.
5
surgeries, this is because maximum time is wasted in instrument 2. Lowenfels AB, Mehta V, Levi DA, Montecalvo MA, Savino
set up like insufflators adjustment, light adjustment, white JA, November 1998, 12:17 > Complications of surgery in HIV-
balancing , access, etc. infected...
Mortality rate in present series of open surgeries is 7.69%. 3. Surgery in patients with HIV-HIV InSite Knowledge Base
The comparative study on laparoscopy shown less mortality Chapter, February 2003-William P. Schecter, MD, University
rate with expertise hands but mortality rate is higher with of California San Francisco Peter Stock, MD, University of
inexperienced hands due to major vessel bleeding. California San Francisco.
Hospital stay during open surgeries varied from 2 to 15 days as 4. Emparan C, Iturburu IM, Portugal V, Apecechea A, Bilbao JE,
Mendez JJ: Infective complications after minor operations in
compared to literatures on laparoscopic surgery, laparoscopic patients infected with HIV: role of CD4 lymphocytes in
surgeries have very less hospital stay, i.e. only 1-2 days. prognosis. Eur J Surg 1995; 161:721-723.
Economically, open surgeries costs 2000 to 12000 rupees 5. Wormer GP. Reduced frequency of percutaneous injuries in
while laparoscopic surgery cost ranges between 15000 to 50000 surgeons. AIDS. 1933;9(2):199-202ZZ.
rupees. The higher cost is due to cost of staplers, hemostatic 6. Laparoscopic surgery for HIV- infected patients: minimizing
instruments. dangers for all concerned. J Laparoendosc Surg. 1991 Oct;
1(5):295-8.
CONCLUSIONS 7. Luigi Boni, Angelo Benevento, Francesca Rovera, Gianlorenzo

Above study revealed following conclusions. Dionigi, Matteo Di Giuseppe, Camillo Bertoglio, Renzo Dionigi.
Compared to traditional operations, there are fewer traumas Surgical Infections. July 1, 2006, 7(supplement 2): s-109-s-111.
doi:10.1089/sur.2006.7.s2-109.
to the skin and muscles and less postoperative pain and 8. Aids and surgery – G Morino, N Laldal, etc. – East African
disability with a laparoscopic procedure. Also, patients have a central journal of surgery, vol.-9, December 2004.
shorter hospital stay and a quicker recovery period. 9. Laparoscopically Assisted Sigmoid Colectomy in Human
There is a reduced infection rate. This is because delicate Immunodeficiency Virus (HIV) Patients: A Good Indication for
tissues are not exposed to the air of the operating room over Laparoscopic Surgery. Brief Clinical Report -Surgical
long periods of time. Laparoscopy and Endoscopy. 6(5):414-416, October
Video magnification also offers surgeons better exposure 1996.Oliveira, Lucia M.D.; Wexner, Steven D. M.D.
of the diseased organ and its surrounding vessels and nerves. 10. Complications of laparoscopic cholecystectomy in HIV and
As a result, delicate manuevers can better be performed. AIDS patients, surgical endoscopy, volume 9, Aug. 1995.
Laparoscopy reduces risk of occupational transmission in 11. Effect of Human Immunodeficiency Virus-1 Infection on
surgical team. Treatment Outcome - of Acute Salpingitis -Nelly R. Mugo, MB
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