Contraindications And Abdominal Injuries Perform by Laparoscopy
As a rule, in addition to these prohibitions, abdominal injuries perform by laparoscopy. The most common causes of intra-abdominal bleeding were small size due to closed abdominal trauma (due to superficial damage to the liver or spleen). Laparoscopic Trainer.
Usage of Simulations is significant choice with Laparoscopic Trainer.
And perforation of the nasopharynx due to perforation and other abdominal injuries. It also treats with endoscopy (retropitoneum or mesenteric hematoma, ruptured diaphragm, ruptured bladder).
As with intestinal obstruction, an optimistic view of laparoscopy in abdominal trauma not given. Therefore, before talking about indications, contraindications mention:
- Hemodynamic instability: it is more serious than in other abdominal emergencies (for this reason, resuscitation not attempts, with the intention of performing laparoscopy afterwards).
- Severe chest trauma: due to mechanical ventilation and gas exchange difficulties that laparoscopy already produces (added to chest trauma).
- Head injury not studied: due to the risk that abdominal hyper-pressure increases intracranial pressure, by transmitting intra-abdominal pressure to the venous drainage of the internal jugular vein through the cava system.
- Suspected rupture of the diaphragm: in this case, a chest drains places before starting the laparoscopy to avoid a tension pneumothorax when performing the pneumoperitoneum, if indeed there is a diaphragmatic rupture.
Apart from these contraindications, in principle, any abdominal trauma treats by laparoscopy. Although the most frequent causes are small hemoperitoneum due to closed abdominal trauma originating in superficial injuries to the liver or spleen.
In these conditions, the main objective of laparoscopy is to avoid exploratory laparotomy without any surgical intervention. Because spontaneous hemostasis of the hemoperitoneum performs or it is a retroperitoneal hematoma. And laparotomy only to perform a minor hemostatic gesture (mainly on superficial erosions in the liver and spleen). Laparoscopic Trainer.
Situations In Conversion to Laparotomy
Within this context, and considering the severity of the polytraumatized patient. A low threshold for conversion to laparotomy maintains in some situations.
- Massive bleeding and bleeding that not controls by laparoscopy.
- Deep wounds (greater than 3 cm) in the liver or spleen,
- No location of the bleeding lesion and
- Expansive splenic subcapsular hematoma or
- Greater than 1/3 of its surface.
The patient positions in the supine position,
- Under general anesthesia,
- The bladder catheterization
- A suction nasogastric tube,
- The lower extremities separated to allow the surgeon to operate from the perineum, and
- Preferably with both upper boundaries collected along the trunk,
to allow the placement of the helper on whatever side requires.
It is convenient to make the first entry with a Hasson trocar in the umbilical position for the optics and to establish an estimation of the h entire surface of the liver and hemorrhage and if possible, a diagnosis. In principle, two more 5-6 mm sheaths places in both voids to be able to manipulate and explore both the upper abdomen cranially, as well as the paracolic gutters and the pelvis caudally.
For it, the patient well secured to the operating table with belts that prevent movement, especially in forced lateral decubitus. Depending on the findings and the need and therapeutic possibilities, other trocars adds or they replace by a 10-11 mm trocar.
For minimally invasive surgery technique, many of them have not received applied training with emulators approximating Laparoscopic Trainer.
Instruments Useful in Traumatic
In this sense, in the hemoperitoneum it is especially useful to use 10 mm suction cannula. Since large clots not aspirates through 5 mm cannulas. Other instruments that are especially useful in the laparoscopic treatment of traumatic hemoperitoneum. These are hemostatic clips, the spray function in the monopolar electric scalpel, the coagulator of argon, the harmonic scalpel, and the Ligature.
Treatment Of Traumatic Hemoperitoneum
In trauma, on the other hand, the laparotomy surgical table must be prepared from the start of laparoscopy, and if the patient becomes hemodynamically unstable during the procedure, without rapid response to the infusion of fluids and blood products, they convert to laparotomy.
It is essential to aspirate all the blood and clots and wash abundantly with hot saline to explore the entire abdominal cavity.
- Retroperitoneum and pelvis,
- Anterior gastric face,
- The entire colic frame,
- The broad surface of the liver and spleen,
- The gallbladder,
- The complete length of the small intestine and
- The urinary bladder
Hemostasis frequently performs with coagulation, but sometimes requires suture stitching. In which case conversion is usually necessary. If the spleen is severely contused and with multiple bruises or fissures. Although not actively bleeding, splenectomy is usually advisable. In these cases, if the patient is very stable and has no other serious traumatic injuries, laparoscopic splenectomy attempts.
When the surgeon has the necessary experience. If conversion requires, laparoscopy-assisted surgery sometimes performs. Expanding the umbilical inlet, especially if it is a wound to the small intestine or its Mesos, repairing intestine openly.
Other Laparoscopic Procedures in Emergencies
It only remains to mention some other more anecdotal urgent situations that performs laparoscopically with benefit for the patient. Such as spontaneous perforations and inflammatory processes of the small intestine.
- Intestinal ischemia,
- Complicated inguinocrural hernia,
- Eosinophilic enteritis,
- Meckel’s diverticulitis,
- Anisakiasis, etc.).
Peritonitis of any cause (the most frequent indication diverticular purulent peritonitis of the large intestine,
- Followed by appendicitis,
- Small intestine peritonitis and
- Some gynecological ones,
- The semi-urgent study of chronic abdominal pain and
- Abscess drainage
- Pericolic abscess in diverticulitis,
- Postoperative pelvic abscess.
All these situations can benefit from the laparoscopic approach, in any of its approaches: diagnostic laparoscopy, assisted laparoscopy and directed laparotomy. Laparoscopic Trainer.
In other words, the intention of laparoscopy in abdominal trauma is fundamentally diagnostic (exploratory laparoscopy, which avoids a blank laparotomy) and marginally therapeutic. In addition, it can increase diagnostic certainty in clinically and radiologically doubtful cases of being susceptible to surgical observation; if there are no injuries, they discharge early with greater safety.
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