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01-07-2016

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

Authors: Antonino Agrusa, Giuseppe Frazzetta, Daniela Chianetta, Silvia Di Giovanni, Leonardo Gulotta, Giuseppe Di Buno, Vincenzo Sorce, Giorgio Romano, Gaspare Gulotta

Published in: Surgical Endoscopy | Issue 7/2016

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, sixty-three 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.

Blum CA, Adams DB (2011) Who did the first laparoscopic cholecystectomy? J Minim Access Surg. 7(3):165–168CrossRefPubMedPubMedCentral

Agrusa A, Romano G, Frazzetta G, Chianetta D, Sorce V, Di Buono G, Gulotta G (2014) Role and outcomes of laparoscopic cholecystectomy in the elderly. Int J Surg. 12(Suppl 2):S37–S39CrossRefPubMed

Saeian K, Reddy KR (1999) Diagnostic laparoscopy: an update. Endoscopy. 31(1):103–109CrossRefPubMed

Agrusa A, Romano G, Frazzetta G, Chianetta D, Sorce V, Di Buono G, Gulotta G (2014) Laparoscopic adrenalectomy for large adrenal masses: single team experience. Int J Surg. 12(Suppl 1):S72–S74. doi:10.1016/j.ijsu.2014.05.050 CrossRefPubMed

Sauerland S, Agresta F, Bergamaschi R, Borzellino G, Budzynski A, Champault G, Fingerhut A, Isla A, Johansson M, Lundorff P, Navez B, Saad S, Neugebauer EA (2006) Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 20(1):14–29CrossRefPubMed

Navez B, Navez J (2014) Laparoscopy in the acute abdomen. Best Pract Res Clin Gastroenterol 28(1):3–17CrossRefPubMed

Di Saverio S (2014) Emergency laparoscopy: a new emerging discipline for treating abdominal emergencies attempting to minimize costs and invasiveness and maximize outcomes and patients’ comfort. J Trauma Acute Care Surg. 77(2):33CrossRef

Agrusa A, Romano G, De Vita G, Frazzetta G, Chianetta D, Di Buono G, Gulotta G (2014) Adrenal gunshot wound: laparoscopic approach. Report of a case. Int J Surg Case Rep 5(2):70–72CrossRefPubMed

Slutzki S, Halpern Z, Negri M, Kais H, Halevy A (1996) The laparoscopic second look for ischemic bowel disease. Surg Endosc 10(7):729–731CrossRefPubMed

10.

McGinty JJ Jr, Hogle N, Fowler DL (2003) Laparoscopic evaluation of intestinal ischemia using fluorescein and ultraviolet light in a porcine model. Surg Endosc 17(7):1140–1143CrossRefPubMed

11.

Kirshtein B, Roy-Shapira A, Domchik S, Mizrahi S, Lantsberg L (2008) Early relaparoscopy for management of suspected postoperative complications. J Gastrointest Surg. 12(7):1257–1262CrossRefPubMed

12.

Alaswad FD. (2013) Treatment options of laparoscopic complications. NMC Speciality Hospital ABDOMINAL SURGERY Official Journal of the American Society of Abdominal Surgeons, Inc. Winter 2012/Spring 2013 issue of the Journal

13.

Dexter SP, Miller GV, Davides D, Martin IG, Sue Ling HM, Sagar PM, Larvin M, McMahon MJ (2000) Relaparoscopy for the detection and treatment of complications of laparoscopic cholecystectomy. Am J Surg 179(4):316–319CrossRefPubMed

14.

Cuccurullo D, Pirozzi F, Sciuto A, Bracale U, La Barbera C, Galante F, Corcione F (2015) Relaparoscopy for management of postoperative complications following colorectal surgery: ten years experience in a single center. Surg Endosc 29(7):1795–1803. doi:10.1007/s00464-014-3862-6 CrossRefPubMed

15.

Agrusa A, Romano G, Frazzetta G, Amato G, Chianetta D, Di Giovanni S, De Vita G, Di Buono G,Sorce V, Gulotta G (2014) The aid of “bedside ultrasonography” for the emergency surgeon: the experience of a single centre. Crit Ultrasound J 6(Suppl 2):A3

16.

Romano G, Agrusa A, Frazzetta G, De Vita G, Chianetta D, Di Buono G, Amato G, Gulotta G (2013) Laparoscopic drainage of liver abscess: case report and literature review. G Chir 34(5–6):180–182PubMedPubMedCentral

17.

Rosin D, Zmora O, Khaikin M, Bar Zakai B, Ayalon A, Shabtai M (2004) Laparoscopic management of surgical complications after a recent laparotomy. Surg Endosc 18(6):994–996CrossRefPubMed

18.

Lee CM, Huh JW, Yun SH, Kim HC, Lee WY, Park YA, Cho YB, Chun HK (2015) Laparoscopic versus open reintervention for anastomotic leakage following minimally invasive colorectal surgery. Surg Endosc 29(4):931–936. doi:10.1007/s00464-014-3755-8 CrossRefPubMed

19.

Wind J, Koopman AG, van Berge Henegouwen MI, Slors JF, Gouma DJ, Bemelman WA (2007) Laparoscopic reintervention for anastomotic leakage after primary laparoscopic colorectal surgery. Br J Surg 94(12):1562–1566CrossRefPubMed

20.

O’Riordan JM, Larkin JO, Mehigan BJ, McCormick PH (2013) Re-laparoscopy in the diagnosis and treatment of postoperative complications following laparoscopic colorectal surgery. Surgeon. 11(4):183–186CrossRefPubMed

21.

Kirshtein B, Roy-Shapira A, Domchik S, Mizrahi S, Lantsberg L (2008) Early relaparoscopy for management of suspected postoperative complications. J Gastrointest Surg. 12(7):1257–1262CrossRefPubMed

22.

Serf R, Ochmann J, Kozumplik L, Vrastyak J, Penka I (1995) The role of relaparoscopy in the management of bile leaks after laparoscopic cholecystectomy. Int Surg 80:356–357

23.

Brooks DC, Becker JM, Connors PJ, Carr-Loke DL (1993) Management of bile leaks after laparoscopic cholecystectomy. Surg Endos 7:292–295CrossRef

24.

Willis VL, Jorgensen JO, Hunt DR (2000) Role of relaparoscopy in the management of minor bile leakage after laparoscopic cholecystectomy. Brit J Surg 87:176–180CrossRef

25.

Leister I, Becker H (2006) Relaparoscopy as an alternative to laparotomy for laparoscopic complication. Chirug 77(11):986–997CrossRef

26.

Vitagliano G, Castilla R, Fernandez Long JG (2013) Relaparoscopy in the treatment of complications after laparoscopic urological procedures. Arch Esp Urol 66(2):215–220PubMed

Title: “Relaparoscopic” management of surgical complications: The experience of an Emergency Center
Authors: Antonino Agrusa
Giuseppe Frazzetta
Daniela Chianetta
Silvia Di Giovanni
Leonardo Gulotta
Giuseppe Di Buno
Vincenzo Sorce
Giorgio Romano
Gaspare Gulotta
Publication date: 01-07-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 7/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4558-2

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Springer Medicine

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

Abstract

Background/aim

Materials and methods

Results

Discussion and conclusion

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Springer Medicine

Abstract

Background/aim

Materials and methods

Results

Discussion and conclusion

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