title: The effects of repeat laparoscopic surgery on the treatment of complications resulting from laparoscopic surgery.
abstract: Laparoscopic surgery is frequently applied in the operative management of appendicitis and symptomatic cholelithiasis because it is a minimally invasive procedure. There are, however, some complications of laparoscopic cholecystectomy (LC) and laparoscopic appendectomy (LA) that result  in the need for reoperation. In the current study, we examine the effects of repeat laparoscopic surgery on the treatment of complications arising from LC/LA. From April 2005 to March 2011, we examined a cohort of patients who had received LC or LA and experienced complications that required  reoperations. We focused on patients with postoperative hemorrhages, postoperative peritonitis, early postoperative small bowel obstructions (EPSBO), and biliary complications (after LC) who were treated through a repeat laparoscopic approach. The general demographics of the patients, their  postoperative complications, procedures for selecting the appropriate reoperation method, and repeat laparoscopic findings are described in detail. During the 6-year period examined, 1608 patients received LC and 1486 patients received LA at the hospitals participating in this study. In patients  with complications requiring reoperation, the repeat laparoscopic approach was performed successfully (without the need for further laparotomy) in 50 per cent of the patients with postoperative hemorrhage (2 of 4), 50 per cent of the patients with postoperative peritonitis (2 of 4), 75 per  cent of the EPSBO patients (3 of 5), and 50 per cent the of patients with biliary complications (1 of 2). The repeat laparoscopic approach is an appropriate method for the management of complications arising from laparoscopic surgery. In patients with postoperative hemorrhage, laparoscopic  hemostasis and hematoma evacuations can be performed while maintaining stable hemodynamics. In addition, laparoscopic approaches are also feasible for selective post-LC ductal injuries, EPSBO, and unconfirmed diagnoses of peritonitis after laparoscopic surgery.
authors.affiliation: Department of Trauma and Emergency Surgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan. drfu5564@yahoo.com.tw
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Fu
authors.forename: Chi-Hsun
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Chun-Han
authors.initials: CH
authors.lastname: Shih
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Wang
authors.forename: Ray-Jade
authors.initials: RJ
authors.lastname: Chen
authors.forename: Hung-Chang
authors.initials: HC
authors.lastname: Huang
authors.forename: Jui-Chien
authors.initials: JC
authors.lastname: Huang
authors.forename: Shih-Chi
authors.initials: SC
authors.lastname: Wu
authors.forename: Catherine
authors.initials: C
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D001064:Appendicitis / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D016896:Treatment Outcome