Endoscopic and laparoscopic alternatives to reoperations for septic abdomen
Chowbey, P.K. (2002) Endoscopic and laparoscopic alternatives to reoperations for septic abdomen. In: Congress of Endoscopic and Laparoscopic Surgeons of Asia, 2002 [ELSA 2002], 19-20 Sep 2002, Tokyo, Japan.
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Post operative intra abdominal sepsis is characterised by persistent tachycardia, leucocytosis, fever, shock and multiple system organ failure. Any patient progressing in this direction requires an immediate and thorough evaluation to determine the source of sepsis. Post surgical abdominal sepsis is a well known complication occurring in 2% of patients undergoing laparotomy and in as many as 23% of patients operated for previous abdominal sepsis. In 15-30% of these patients the intra abdominal abscesses are multiple and the mortality rate following a relaparotomy are as high as 29-71%. Patients with a single localized collection fare better with mortality rates ranging 3-13%. A CT Scan is the best study for determining the location and multiplicity of the collections and also offers the option of attempting a percutaneous drainage procedure. These patients are known to fare better if appropriate drainage can be achieved with minimal invasiveness. On the same principles one can apply laparoscopy as a diagnostic and therapeutic tool in the management of these morbid patients. Several studies on role of laparoscopy in acute abdominal conditions have established its comparatively safe application even in severely morbid patients. Published data has shown a 96% success rate of providing adequate drainage to the septic foci with laparoscopy. Our own experience has shown laparoscopy to be an excellent modality in management of post surgical abdominal sepsis. Video recordings supporting the same will be presented with description of the minimal invasive approach. We will like to conclude that laparoscopy is a versatile tool both for establishing diagnosis and for therapeutic intervention. It avoids unnecessary diagnostic studies and averts delays in operative intervention. It is associated with minimal surgical morbidity and ensures a rapid recovery and shorter hospital stay.
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