Laparoscopy was initially used for diagnostic and therapeutic purposes. But with the advancement of medical sciences, the role of laparoscopy was extended for emergency settings also. Emergency Laparoscopic treatment of acute abdomen was first proposed by Philippe Mouret in 1990 and since then it is being widely used for abdominal emergencies, especially- acute cholecystitis, appendicitis, perforated ulcers, Ectopic pregnancies,abdominal bleeding etc. Peptic ulcer perforation is the second most frequent abdominal perforation requiring surgery and accounts for 5% of abdominal emergencies.
Dr. Manish Motwani, an eminent laparoscopic surgeon and founder of Aastha healthcare, comments," When patients come to the emergency room, we prefer laparoscopy as it helps us to conduct an immediate diagnosis and can initiate treatment right there." Aastha is well equipped to handle any kind of emergencies. It is well equipped with all modern facilities and is supported by qualified and experienced surgeons. Laparoscopic surgery has improved our management of surgical emergencies and in certain conditions is now an essential part of our armamentarium. What is clear is that as surgical expertise and technology both continue to improve, so the remit for laparoscopic surgery will expand, to the benefit of our patients.
When emergency laparoscopy is performed, there can be two clinical scenarios :
* In some emergency cases, diagnosis is done and a specific line of action is planned. Laparoscopic procedures are then performed.
* In few cases, the abdominal pathology is uncertain or doubtful. In these cases, the primary aim of laparoscopy is diagnostic and then corrective.
What are the operations possible through emergency laparoscopy?
* Diagnostic Laparoscopy for Acute Abdominal Pain.
* Laparoscopy for Abdominal Trauma (Blunt and Penetrating)
* Laparoscopic Management of Intestinal Obstruction.
* Laparoscopic Management of Diverticulitis.
* Laparoscopy for Acute Appendicitis.
* Complicated ovarian cysts.
* Pelvic inflammatory diseases.
* Acute salpingitis.
* Intestinal adhesions.
* Mesenteric adenitis.
* Ectopic pregnancy.
* Endometriosis.
* Complicated Meckel's diverticulum.
* Omental necrosis.
* Intestinal infarction.
* Acute diverticulitis.
* Bedside Laparoscopy in the ICU.
* Laparoscopic Management of Perforated Ulcer.
* Laparoscopy for Intestinal Ischemia.
* Laparoscopic Re-operations for Postoperative Complications.
Emergency laparoscopic orchidectomy for torsion of intra-abdominal testis.
How it is done?
The emergency laparoscopy is done in the same way as elective laparoscopy. The only thing is that the surgeon must be well qualified. Emergency Laparoscopy is generally performed under general anesthesia. Once the patient is under anesthesia, a urinary catheter is inserted to collect urine during the procedure. To begin the procedure, a small incision is made just below the navel and a cannula or trocar is inserted into the incision to accommodate the insertion of the laparoscope. Other incisions (one or two) may be made in other areas of the abdomen to allow for insertion of other laparoscopic instrumentation. A laparoscopic insufflation device is used to inflate the abdomen with carbon dioxide gas to create a space in which the laparoscopic surgeon can maneuver the instruments. Laparoscopes, which have integral cameras for transmitting images during the procedure, are available in various sizes depending upon the type of procedure being performed. The images from the laparoscope are transmitted to a viewing monitor, which the surgeon uses to visualize the internal anatomy and guide any surgical procedure. After laparoscopic treatment is completed, the laparoscope, cannula, and other instrumentation are removed, and the incision is sutured and bandaged.
Generally the patient recovers faster than he would in an open surgery. But Ofcourse it all depends upon on the diagnosis of the patient at the time of operation and what the surgeon did to treat the disease. In most of the cases, the patients are encouraged to move about after few hrs of surgery. They can resume their normal activities after 7-12 days after surgery, depending upon the condition.
Benefits of emergency laparoscopy
Emergency laparoscopy has a huge benefit of providing faster recovery rate. Let us see the benefits of emergency laparoscopy for patients:
* Accurate diagnosis of the pathology inside the abdomen.
* Diagnostic and therapeutic surgery is possible at the same time.
* Less post-operative pain.
* Faster recovery.
* Short hospital stay.
* Less post-operative complications like wound infection, adhesion, hernia, etc.
* Cost-effective in working group.
Contraindications of emergency laparoscopy
Relative contraindications to emergency laparoscopy are :
* The general anaesthesia and the pneumoperitoneum required as part of the laparoscopic procedure may increase risk in certain patient groups. Most surgeons would not recommend emergency laparoscopy in:
* Patients with cardiac diseases and COPD are not good candidate for emergency laparoscopy.
* Patients who have had previous extensive abdominal surgery, emergency laparoscopy may be difficult.
* Those with diminished cardio-pulmonary reserve are also at risk because of the adverse effects of the pneumoperitoneum on the CVS and a longer operative time.
* Those with bleeding disorders or defective haematological values or pre-existing debilitating disease are also not a good candidate for emergency laparoscopy
