Simplified laparoscopic approach to "second-look" laparotomy: a review.
Acute mesenteric vascular accidents are being diagnosed more commonly as a consequence of an aging population and often result in emergency bowel resection for ischemia. Because predicting postoperative intestinal viability remains difficult, second-look laparotomy has been advocated to improve outcomes. Recently, laparoscopy has emerged as an alternative to laparotomy for the diagnosis and treatment of ongoing postoperative ischemia. A review of the literature since 1994 reveals that, to date, 19 procedures have been reported to prevent 13 (68%) unnecessary laparotomies. We describe our laparoscopic second- look technique and review the literature. Second-look laparoscopy has been shown repeatedly to be a safe alternative to laparotomy. It is simple and reduces negative second-look laparotomy in critically ill patients.
Seshadri
P A
PA
Centre for Minimally Invasive Surgery, University of Toronto, St. Michael's Hospital, Ontario, Canada.
Poulin
E C
EC
Mamazza
J
J
Schlachta
C M
CM
D000368:Aged; D001064:Appendicitis / Q000175:diagnosis; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis / Q000601:surgery*; D007416:Intestinal Perforation / Q000175:diagnosis; D007511:Ischemia / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008643:Mesentery / Q000098:blood supply*; D012086:Reoperation / Q000379:methods; D012680:Sensitivity and Specificity