ROLE OF LAPAROSCOPY IN ACUTE ABDOMEN

Abstract

Background: acute abdomen refers to signs and symptoms of abdominal pain and tenderness, a clinical presentation that often requires emergency surgical therapy. This challenging clinical scenario requires a thorough and expeditious workup to determine the need for operative intervention and initiate appropriate therapy. Many diseases, some of which are not surgical or even intra-abdominal, can produce acute abdominal pain and tenderness. Therefore, every attempt should be made to make a correct diagnosis so that the therapy selected, often a laparoscopy or laparotomy, is appropriate.Objective:To it's aiming to minimize unnecessary laparotomies. Patients and methods: We performed a prospective clinical study on 40 patients suffering from abdominal pain, presented to the emergency department of Zagazig University Hospitals during the period from May 2011 to May 2012. All patients included in this study were presented with acute abdominal pains. Exclusion criteria: According to the following; patients were excluded from the study:all patients younger than 12 years old, hemodynamically unstable till stabilisation of the case, patients with uncorrected coagulopathies, patients with multiple previuos abdominal surgical procedures and patients with intestinal obstruction with diffuse abdominal distension. Operative Techniques; Patient position: All laparoscopic procedures were done in the operative theatre; the patient is placed supine on the operating table with the legs straight. Anaethesia: It was performed under general anaethesia. Creation of pneumoperitoneum: -either the open technique or the veress needle was used to establish pneumoperitoneum according to individual surgeon preference.-the location usually was periumbilical.Port location:10 mm laparoscope was used through umbilical port.An accessory 5mm port was then used under vision in the left upper quadrant along the linea semilunaris, halfway between the umbilicus & the costal margin this was needed for the palpating probe and suction/coagulation cannula. Other accessory ports were inserted in other sites as needed.Inspection: After inspecting the trocar entry sites and the anterior surfaces of the abdominal viscera, general inspection of the peritoneal cavity and its cotents proceeded this was followed by specific inspection of diseased organs. Statistical analysis: SPSS version 15. Results: Laparoscopy showed results better than that of open repair as regard postoperative pain, operative time, hospital stay and most of complications. Conclusion: The emergency laparoscopy is a diagnostic and therapeutic option in the majority of acute abdominal pain conditions, to minimize unnecessary laparotomies it is a promising solution.
Keywords: acute abdomen - laparoscopic - repair.