“Relaparoscopic” management of surgical complications: The experience of an Emergency Center

Abstract

Background/aim Laparotomy has been the approach of choice for re-operations in patients with surgical complications. The aim of this retrospective analysis was to evaluate the feasibility and the safety of laparoscopic approach for the management of general abdominal surgery complications. Materials and methods We report a retrospective review of 75 patients who underwent laparoscopic evaluation for postoperative complications over a 4-year period. Primary outcomes (resolution rate by exclusive laparoscopic approach, conversion rate, further surgery rate) and secondary outcomes (mortality, hospitalization, prolonged ileus, wounds problems and median operative time) were evaluated. Results Sixty-six patients (88 %) were managed with laparoscopic approach without conversion; of these, sixtythree patients (84 %) had no more or further complications and were discharged from hospital between 4 ± 3 days after ''second-look'' surgery; three patients (4 %) developed postoperative complications requiring a third surgery.Nine cases (12 %) underwent conversion in open surgery after laparoscopic approach. Two elderly patients (2.7 %) died in intensive care unit, because of multi-organ failure syndrome. Median time elapsed between an intervention and another was about 2.5 ± 9.5 days. Mean operative time was 90 ± 150 min. Postoperative hospital stay was between 4.5 and 18 days. Discussion and conclusion Laparoscopy has begun to be the preferred method to manage postoperative problems, but only few reports are available actually. Our experience in ''relaparoscopic'' management of surgical complications seems to suggest that laparoscopy ''second look'' is an effective tool after open or laparoscopic surgery for the management of postoperative complications and it may avoid diagnostic delay and further laparotomy and related problems.

Laparoscopic adrenalectomy: preoperative data, surgical technique and clinical outcomes

“…Among these patients 4 presented bleeding: 1 vena cava injury treated with intracorporeal sutures and positioning of pre-rolled TachoSil®; 1 from a small hepatic accessory vein that was isolated and clipped; 1 caused from a spleen injury during left adrenalectomy, in this case hemostasis was obtained with use of hemostatic matrix (Floseal®); 1 from peri-renal tissue solved by positioning of Hemopatch®. In another patient with a large right adrenal masses (14 cm) we observed a diaphagmatic lesion treated with suture and intra-corporeal knotting with no transthoracic drainage [16,17]. No conversion to open surgery was necessary and no intraoperative blood transfusion were required.…”

Mannheim Peritonitis Index (MPI) and elderly population: prognostic evaluation in acute secondary peritonitis

“…It is well known the correlations between pharmacological strategies, such as in Crohn's disease, and the risk to develop rare tumors or complications such as bowel perforation. Bowel herniation also represents a risk factor of perforation (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). Multiple Organ Failure (MOF) represents the fatal evolution of the peritonitis (4).…”

Minimally invasive surgery for the management of major bile duct injury due to cholecystectomy

“…Full texts were thus evaluated, including the relative references of each study. Finally, a total of 31 reports were included in the analysis . The PRISMA diagram is given in Figure .…”