Role of Laparoscopic Surgery in the Management of Acute Abdomen in the HIV-Positive Patients

Abstract

Emergency open laparotomy in patients infected with HIV is accompanied by high mortality. The authors investigated the potential role of a laparoscopic approach for the management of acute abdomen in such patients. Prospectively, 10 patients with HIV disease (9 with AIDS) underwent laparoscopy for acute abdomen. The treatment was exclusively laparoscopic in 6 patients. A conversion to laparotomy was necessary in 4 patients but through guided elective incision in 3 of them. The postoperative course was uneventful in all patients but 1, who died. We advocate a laparoscopic approach, when feasible, as an initial step in the management of acute abdomen in HIV-positive patients.

The efficacy of laparoscopic surgery in the diagnosis and treatment of peritonitis

“…Finally, two possible additional advantages of the laparoscopic approach are the reduced immunosuppression observed in response to the surgical trauma, and recently, Fry [15] reported a reduced risk of transmission of viral infections such as HIV in surgeons and medical personnel [13], a point also made by Bouillot et al [2]. On the other hand, although the expulsion of live particles during the evacuation of pneumoperitoneum has been shown, to this date there is no evidence that HIV can be transmitted in this way [2,3]. We recommend evacuating the smoke and pneumoperitoneum with a suctionirrigation system.…”

Outcomes of Laparoscopic and Open Appendectomy for Acute Appendicitis in Patients with Acquired Immunodeficiency Syndrome

“…Many studies have reported a higher rate of morbidity and mortality in urgent appendectomies for acute appendicitis in patients with acquired immunodeficiency syndrome (AIDS) because of the diagnosis and surgical management delay, the surgeon's worry of opportunistic infections, and weakened immune responses. 2,[6][7][8] Although one study has demonstrated the benefits of laparoscopic appendectomy (LA) 9 in HIV-infected patients, no study has compared LA versus open appendectomy (OA) in AIDS patients. This study is the largest nationwide study available for appendicitis in patients with AIDS.…”

Laparoscopy in the evaluation and treatment of patients with AIDS and acute abdominal complaints

“…In the AIDS patient it can be used to evaluate and treat both specific and nonspecific clinical presentations [2,12]. The surgeon can obtain fluid for cytology and culture and tissue for inspection.…”