Laparoscopic management of surgical complications after a recent laparotomy.
BACKGROUND
The use of laparoscopy in the scarred abdomen is now well established. However, recent laparotomy and the presence of a fresh abdominal wound usually preclude laparoscopic intervention. Thus, early postlaparotomy complications, which mandate surgical interventions, are usually treated by a second laparotomy. We report our experience with the use of laparoscopy for the treatment of postoperative complications, after open abdominal procedures.


METHODS
Fourteen patients were operated for a variety of conditions, and postoperative complications, such as bowel obstruction, intraabdominal infection, or anastomotic insufficiency, were handled laparoscopically.


RESULTS
Eleven patients recovered from the acute condition. One patient died from sepsis, one retroperitoneal abscess was missed and later drained percutaneously, and one conversion to open surgery was necessary because of adhesions and lack of working space.


CONCLUSIONS
We conclude that a recent laparotomy is not a contraindication for laparoscopic management of acute abdominal conditions. Postlaparotomy complications can be successfully treated by laparoscopy. Avoiding the reopening of the abdominal wound and a second laparotomy may reduce the additional surgical trauma, and thus result in easier recovery.
Rosin
D
D
The Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel. drosin@mac.com
Zmora
O
O
Khaikin
M
M
Bar Zakai
B
B
Ayalon
A
A
Shabtai
M
M
D000714:Anastomosis, Surgical; D001062:Appendectomy; D002921:Cicatrix / Q000601:surgery; D003082:Colectomy; D005547:Foreign Bodies / Q000601:surgery; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D007511:Ischemia / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D008643:Mesentery / Q000098:blood supply; D019060:Minimally Invasive Surgical Procedures; D010439:Peptic Ulcer Perforation / Q000601:surgery; D010538:Peritonitis / Q000209:etiology / Q000601:surgery; D011027:Pneumoperitoneum / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D024162:Second-Look Surgery / Q000379:methods; D013529:Surgical Wound Dehiscence / Q000601:surgery; D000267:Tissue Adhesions / Q000601:surgery; D016896:Treatment Outcome