Indications for laparoscopy and possible complications

For a thorough examination of the abdominal organs, retroperitoneal space, and small pelvis, invasive and minimally invasive manipulations are used. Laparoscopy plays an important role for emergency diagnosis in these cavities.

For emergency diagnosis of peritoneal diseases, the laparoscopic method is used.

What is laparoscopy?

Laparoscopy is an endoscopic examination of the abdominal organ, small pelvis. Refers to minimally invasive treatment methods, allows you to visualize all organs of the abdominal cavity, retroperitoneal space, as well as perform surgical intervention.

Allows visualization of all peritoneal organs.

It is used in situations where using other diagnostic techniques it is not possible to accurately determine the nature of the disease. Minor injury and the relative technical ease of the method have led to its widespread use in clinical diagnostics, including in childhood and the elderly.

Surgical laparoscopy is also widely used with diagnostic laparoscopy, in particular for drainage of the peritoneum and adhesive disease. It is often used for excision of part of an organ, for example, for various cysts of the kidneys, liver, pancreas, as well as for some gynecological operations.

Types of laparoscopic operations and indications for them

Laparoscopy of the abdominal cavity is of 2 types: diagnostic and therapeutic, and can also be planned and emergency.

Planned manipulation is carried out when:

Neoplasms on the kidney are also removed laparoscopically.

• tubal, peritoneal infertility;
• cystic neoplasms;
• adenomyosis;
• improper formation of the genital organs;
• pain in the lower epigastric region of unknown etiology;
• to create artificial obstruction of the fallopian tubes.

Emergency has the following indications:

• ectopic pregnancy;
• ovarian hemorrhage or infarction;
• torsion or rupture of the stem of the tumor process;
• differential diagnosis between acute surgical or gynecological disease;
• inflammation of the peritoneal and pelvic organs.

The role of diagnostic laparoscopy

Diagnostic laparoscopy is used to examine the organs and tissues of the abdominal cavity. It provides the best view of organs compared to resection of the peritoneal wall, since the endoscope magnifies the examined cavities several times.

Provides the best view of the abdominal organ.

It also allows you to carefully examine the entire space of the abdominal cavity and perform an inspection of hard-to-reach places. If urgently necessary, perform surgical intervention (for example, to stop bleeding, perform resection of a cystic formation, or excision of tissue).

Indications

Quite often, gynecological laparoscopy of the abdominal organ is performed due to reduced tissue trauma and less possible development of undesirable consequences. Most often used in nulliparous or infertile girls.

Indications for diagnostic purposes:

• diseases of the liver, biliary tract;
• suspicion of an acute surgical disease, organ injuries, especially in an unconscious state of the patient;
• acute stomach;
• adhesive process;
• diseases of the pelvic organs (for example, infertility);
• pathological accumulation of fluid in the abdominal cavity;
• if you suspect tumors of the peritoneum and pelvis.

Indications for therapeutic purposes:

• with jaundice of mechanical origin;
• acute inflammation of the wall of the gallbladder and pancreas;
• conditions that require the application of fistulas to the gastrointestinal tract (intestinal obstruction);
• maxillofacial injuries;
• severe brain damage;
• cystic neoplasms of the pylorus;
• burn conditions of parts of the digestive system.

Preparation for surgery and pain relief methods

The preparatory stage for a planned examination of the abdominal organ includes:

An extensive blood test is required before surgery.

• general and biochemical blood test;
• OAM;
• blood clotting test;
• X-ray examination of the chest organs;
• ECG;
• blood tests for HIV, syphilis and hepatitis;
• Ultrasound of the peritoneum and pelvis;
• for laparoscopy in gynecology: vaginal smear, cytological examination of the cervix.

Also, for a clearer picture, the following may be prescribed: CT, MRI, colonoscopy and other examinations.

With emergency laparoscopy, the number of examinations is reduced to a minimum. An electrocardiogram, CBC, OAM are performed, blood is taken for coagulation, group, and Rh factor.

If the test results do not reveal any changes, the doctor will appoint a day for the intervention. However, in the presence of concomitant pathologies, the doctor determines the extent of their course and prescribes appropriate therapy or refers for consultation to specialists.

The therapist also needs to exclude contraindications:

• critical conditions;
• heavy bleeding;
• DN;
• SSN;
• blood clotting disorders;
• liver, kidney failure;
• oncological diseases.

Intervention is not recommended if there is:

In cases of severe obesity, surgery is not recommended.

• the body is allergic to certain medications;
• inflammation of the petals of the abdominal cavity;
• extensive adhesions;
• last trimester of pregnancy;
• severe obesity;
• internal and external hernias;
• oncology.

Also, manipulation is prescribed with great caution if the patient has suffered from an acute respiratory viral infection or a viral disease during the previous month.

The exact date for the manipulation is set by the therapist. He also cancels or allows the use of medications, for example, blood thinners are canceled 14 days before the intervention, and medications that lower blood pressure or blood sugar, diuretics and others can be taken as usual (but in consultation with a specialist).

After everything is provided before the operation, the patient is sent for a consultation with a surgeon. During the conversation, you can find out all the questions that concern you, both about the operation itself and about the postoperative period.

The patient is prohibited from eating food 8 hours before laparoscopy, and drinking alcohol 5 days before. To further cleanse the intestines, specialized products are prescribed or an enema is prescribed. Empty your bladder 60 minutes before surgery.

For laparoscopy, intubation anesthesia is often used. It depends on the duration of the operation (up to 1.5 hours).

For laparoscopy, intubation anesthesia is often used.

In rare cases (allergy to general anesthesia), local anesthesia is indicated. The drugs are predominantly administered intravenously. But preference still remains with combined anesthesia, in which anesthesia through the respiratory system is added to the administration of the drug through a vein.

Laparoscopic technique

The algorithm for performing laparoscopy has several important stages.

1. Treatment of the surgical field.
2. Puncture of the anterior wall of the abdominal cavity.
3. Carbon dioxide injection.
4. Removing the Veress needle.
5. Insertion of a tube with a trocar.
6. Introduction of the laparoscope.

Location of tools.

After diagnosis, surgeons choose a further strategy of action. These may include:

• emergency surgery;
• collection of material for histology;
• laparoscopic drainage of the abdominal cavity to remove accumulations of pus;
• standard completion of the operation (removal of instruments, removal of gas from the peritoneum).

Upon completion of the entire process, cosmetic stitches are applied.

Postoperative period and possible complications

The postoperative period usually lasts up to 2 weeks. In the first hours after the intervention, you are allowed to drink water without gases. After a day, the diet expands. You can eat low-fat light foods (steamed fish, broth, fermented milk products, etc.).

Sutures after laparoscopy are removed after 14 days. Scar changes that remain at the site of the sutures completely resolve after some time.

The scars disappear completely after some time.

Any physical activity or lifting heavy things is strictly prohibited for 3 weeks after surgery.

The main undesirable consequences are:

• soreness in the peritoneum;
• fainting;
• suppuration of sutures;
• swelling;
• bleeding.

It is also possible that fluid may accumulate in the abdominal cavity after laparoscopy. However, complications during laparoscopy are extremely rare.

The feasibility of the method is determined only by a specialist.

The intervention copes well with the task, provides an excellent examination of the abdominal cavity and pelvis, which can combine therapeutic actions.

Laparoscopy increases the accuracy of the surgeon's actions, has a minimal risk of complications and a significant reduction in the duration of the recovery period after surgery.

Source: https://kistateka.ru/bryushnaya-polost/laparoskopiya-organov

Contraindications for laparoscopy - when the operation cannot be performed

Content

• In what cases is laparoscopy used?
• Contraindications to the use of laparoscopy
• Benefits of this type of treatment
• Recovery period after laparoscopy
• Doctors' opinion

Laparoscopy is a fairly common method of surgical intervention. It is used in many fields of medicine. Most often in surgery and gynecology. Laparoscopy of appendicitis is performed mainly when the inflammation is in acute form. It is impossible to delay the operation, as peritonitis may develop.

In what cases is laparoscopy used?

Acute appendicitis is one of the most common pathologies of the abdominal cavity. There is a classic method of removing the appendix and a laparoscopy method. With the classic removal of an inflamed appendix, a number of possible complications are noted: from poor visibility to a long recovery period.

All this can be avoided if there are no contraindications to removing appendicitis through laparoscopy. Modern medical equipment allows such an operation to be performed with minimal risks.

• Chronic appendicitis symptoms
• Appendicitis is considered one of the most common pathologies of the abdominal cavity. It can occur in all people...
• Direct indications for laparoscopy are:

• appendicitis;
• mucocele;
• cysts;
• benign neoplasms;
• carcinoma.

A surgical intervention such as laparoscopic appendectomy is performed only for acute inflammation of the appendix. Surgeons also identified several separate groups of patients with certain concomitant diseases for whom laparoscopy was indicated:

1. Cases when preventive or diagnostic laparoscopy can turn into therapeutic. If using conventional examination methods it is impossible to accurately diagnose the severity of the inflammatory process, then this method is indicated.
2. Young women in whom it is difficult to distinguish gynecological pathology from an aggravated appendix.
3. People who value cosmetic effects. Scars from laparoscopy are practically invisible because the surgical field is very small.
4. Patients who suffer from diabetes mellitus, which can provoke the development of a purulent infection.
5. Children whose likelihood of developing adhesions is significantly reduced after surgery.

An important reason for performing this type of surgical intervention is the desire of the patient himself. In this case, the surgeon who will perform the operation must warn the patient about all possible risks and complications of this method.

Contraindications to the use of laparoscopy

Although laparoscopy has a minimal number of risks and contraindications, they still exist. Direct contraindications to appendectomy surgery are:

• renal and heart failure;
• liver dysfunction;
• late pregnancy;
• poor blood clotting.

Pregnancy is considered a relative contraindication. If the woman’s condition is normal and there are no pregnancy pathologies, then surgery can be performed if particularly necessary. It allows you to maintain pregnancy and not harm the fetus due to its minimally invasive nature.

Bleeding disorders in some cases can lead to large blood loss. Using the method of minimally invasive laparoscopy, this can be avoided, since surgical intervention will be minimal.

1. Inflammation of appendicitis symptoms
2. One of the most severe and controversial pathologies in adults and children is inflammation of appendicitis. So dangerous...
3. For older people, children, people who have an atypical location of the appendix or who have already developed peritonitis, the decision to perform such an operation is made individually.
4. In addition to the general indications for which the operation cannot be performed, there are also local contraindications to it:

1. Dense inflammatory infiltrate in the appendix itself and around its mesentery.
2. Multiple adhesions.
3. The process of developing an abscess that can rupture and lead to peritonitis. Any manipulation of such an abscess can be fraught with damage to the blood vessels.
4. Advanced peritonitis, requiring only open surgery with complete bowel cleansing.

All these contraindications must be taken into account when prescribing laparoscopy. The doctor must carefully examine the patient's condition in order to decide on an operation.

Recovery period after laparoscopy

After the procedure, as after any surgical intervention, the patient must spend up to 6 hours in bed without getting up. If the wounds heal normally, the postoperative scar does not fester or bleed, the sutures are removed already 6-8 days after the operation.

If the sutures become wet or begin to fester, the patient is given additional treatment with Iodinol. In case of serious suppuration, the sutures are treated with a solution of brilliant green 2-3 times a day.

Most often, such operations are performed using special absorbable threads. They dissolve on their own, fall off and leave no trace behind.

Also, after such an intervention, the patient must be given an antibiotic injection. It protects against the development of any kind of inflammation and possible suppuration. During the recovery period, the patient is strictly prohibited from any physical activity.

The patient is prescribed a strict diet. You need to exclude everything fatty, fried, salty, and smoked from your diet. Proper nutrition will help the intestines recover faster and avoid complications such as constipation.

Prevention of appendicitis in adults

The structure of the intestinal system is very complex. The human cecum has a small curved appendage that...

Most doctors consider laparoscopy to be a simple operation. If there is a question about performing it or performing abdominal surgery, they will be on the side of the former. If the patient follows all the doctor’s recommendations when preparing for laparoscopy and in the postoperative period, the risk of complications is significantly reduced.

The operation itself is not complicated. Many doctors even advise patients to choose this particular treatment method. Everything will go fine if the patient has no contraindications. Otherwise, if your general health does not allow it, the doctor may prescribe conventional abdominal surgery. Although the risks after it may be even greater than after laparoscopy.

It is important to understand that the more obedient the patient is, the faster his recovery process will be. Laparoscopy is considered a simple, minimally invasive method for the treatment and diagnosis of abdominal organs, which replaces abdominal surgery. But, if you do not follow the recommendations of the treating doctor, even after it there can be serious complications.

What is this organ used for and is it possible to live normally without it?

You must understand that this is an important organ, but without it you can live a full life. This is an organ of the digestive system, it is like a vessel for bile. Bile itself is involved in the digestion process and enhances the contraction of the walls of the organ.

What symptoms indicate that something is wrong with the gallbladder? Just don’t try to diagnose yourself based on the listed signs now, I beg you. Only a doctor will do this and only with an appropriate examination.

The first calls to see a doctor

And it all starts with sharp and severe pain appearing on the right side and radiating to the stomach. And not necessarily after eating, but during simple physical labor. We bent down to wash the floor and it started to hurt.

There is no feeling of bitterness in the mouth, no increased pain after eating. Therefore, some people think that the stomach hurts, the heart is acting up, or the problem is in the liver.

You cannot make a diagnosis yourself. Not all of us have medical education, so in no case do we prescribe treatment for ourselves. Here you can make a big mistake and lose valuable time. Since the pain radiates down and up, it seems as if something else is hurting.

In what cases is the bile sac removed?

After passing all the tests and other adequate procedures, a diagnosis is made. If it turns out that it is the gallbladder that has become ill, then the diagnoses may be as follows:

• stones in the gallbladder;
• stones in the bile duct;
• cholecystitis. This is an inflammation of the walls of the bile sac. There are stone or tubeless cholecystitis;
• empyema (accumulation of purulent contents in the gallbladder during its inflammation) and hydrocele of the gallbladder;
• neoplasms (polyps, cancer).

The doctor may prescribe a number of treatment measures:

• drug therapy;
• diet using medicinal mineral waters;
• Duodenal sounding is the stimulation of contraction of the walls of the gallbladder. Painful procedure. A probe (tube) is inserted through the esophagus. A special solution is infused through this tube, which helps remove stagnant bile. Brrrrrrr…..

If these methods do not help eliminate the gallbladder lesion, it is removed.

Why me? or causes of diseases

Why do gastrointestinal diseases still occur? Typically the reasons are:

• infections: E. coli, staphylococcus, Pseudomonas aeruginosa and other bacteria;
• viral hepatitis;
• change in the chemical composition of bile. The bile becomes thick, is not excreted, and stagnates. Sand appears, and later this leads to the formation of pebbles;
• violation of the outflow of bile. Bile stagnates in the organ and this causes pain and other symptoms;
• parasitic infections;
• abnormal organ structure, genetic factor;
• neoplasms;
• dysfunction of the liver and pancreas.

Almost all of the above factors cause organ enlargement. And the doctor will immediately see this on an ultrasound.

So, we gathered our strength: an operation was ahead.

I already have a referral for surgery; surgery is scheduled for Monday, June 26, 2017. After the operation, I will write down my feelings and if they give me a stone, I will present it for everyone to see.

What are the different ways to remove gallbladder:

• strip (open) operation;
• laparoscopy.

In the first case, everything is clear. Surgeons will make an incision and remove the organ. This takes from 40 minutes to 1.5 hours. This removal option will bring more difficulties to the patient. The recovery period is much longer - about 6 months. The scar healing process can be painful and problematic.

This method is prescribed if the patient has previously had stones removed and there are scars left on the gallbladder.

Laparoscopy is prescribed if the disease is not advanced. Also, everything is carried out under general anesthesia, but there is a pleasant moment in this, just imagine. They won't cut. And everything about everything - about 1 hour.

The surgeon makes 4 small holes (about 1 cm each). Special tubes are inserted through these holes. One of these tubes is equipped with a video camera so that the surgeon can see everything and carry out the necessary manipulations.

The doctor himself removes the gallbladder through a cosmetic puncture in the navel. At the end of the entire procedure, the doctor examines the cavity for bleeding vessels. Then the patient is injected with a special antiseptic solution, which is then sucked off.

The punctures are sutured, and in some cases even simply covered with a special bandage. But a drainage tube is inserted into one of the holes. It is connected to a special bag into which the remaining antiseptic liquid will drain. After two days, the tube is removed and the hole is sutured. Afterwards, the patient is observed for another 2-4 days and discharged.

Pitfalls - what are the contraindications to laparoscopy?

The laparoscopic method is better, don’t you agree? But there are a number of contraindications, based on which the doctor still prescribes strip surgery:

• pancreatitis in the acute stage;
• serious diseases of the cardiovascular system;
• severe diseases of the respiratory system;
• late stages of pregnancy;
• the location of the gallbladder is close to the liver;
• if jaundice has developed due to obstruction of the biliary tract;
• presence or questionable malignant tumors in the gallbladder;
• acute cholecystitis;
• fistulas;
• blood clotting disorder;
• if the patient has a pacemaker;
• overweight (obesity 2 or 3 degrees).

Therefore, my dears, do not under any circumstances allow the disease to progress to an advanced state. Consult a doctor and get tested if you feel unwell.

It is recommended to remain on sick leave for 10 to 12 days. On days 7-10, the sutures are removed. In some cases, the surgeon may use self-absorbable materials.

Rehabilitation includes physiological and psychological aspects. And after just half a year, both mentally and physically, the patient returns to normal, and you can return to your usual physical activities.

Normal physical well-being occurs within 10-15 days. It's more a matter of psychology. How does a person feel about the operation, how is he determined to recover?

What you can and cannot do after removal

After surgery, the following rules must be observed:

• exclude any loads for a month. After this period has expired, you should return to your normal physical activity gradually, in doses;
• abstain from intimacy for 2 weeks to 1 month;
• eat right (immediately after the operation and for three to four months after it, meals are prescribed according to table No. 5);
• During the first quarter after surgery, you should not lift anything heavier than 3 kg, and from 3 months to six months after removal of the gall sac, you should not lift anything heavier than 5 kg.

This is the conclusion I made after studying all the information on this issue. My dears, eat right, exercise, walk more, love and be loved. Health to you and your loved ones.

Source: https://healthage.ru/polezno-znat/protivopokazaniya-dlya-laparoskopii-kogda-nelzya-provodit-operaciyu/

Laparoscopy: indications, contraindications, how to prepare for surgery, advantages and disadvantages

Laparoscopic surgery is a minimally invasive procedure used in the treatment of gynecological diseases and internal abdominal organs. Carried out for diagnosis and treatment.

Laparoscopy is easier to tolerate than surgery, and therefore is trusted by doctors and patients. Read more on the expert website https://puzyr.info/osobennosti-provedeniya-laparoskopii/

The essence of laparoscopic surgery

Laparoscopy is a progressive method in modern surgery. The intervention from the procedure in the body is minimal. During abdominal surgery, scalpels are used and abdominal incisions are made. Laparoscopy is limited to several small incisions on the abdominal wall using a laparoscope and trocars.

Modern models of devices are equipped with cameras with digital matrices, which allow transmitting the smallest details of the image, which eliminates the risk of operational errors. This greatly facilitates the diagnosis and treatment of patients. Auxiliary devices are manipulators that replace conventional surgical instruments.

Laparoscopy is performed under general anesthesia, as tumors and cysts are removed. The holes are quickly closed with several stitches. If the patient's health is satisfactory, he is discharged after the procedure within a few hours.

Why is laparoscopy done?

Laparoscopy in gynecology is prescribed for diagnostic purposes or for the treatment of pelvic organs. Less commonly, the method is used for the treatment and examination of other organs located in the epigastric region. Suitable for diagnosing and removing tumors in the field of oncology.

In what cases can laparoscopic examination and therapy be prescribed:

1. Female infertility of unknown etiology.
2. Ineffectiveness of hormonal therapy for the purpose of conception.
3. Suspicion of ectopic pregnancy.
4. If ovarian surgery is required.
5. Examination to determine the cause of pain in the lower abdominal cavity.
6. Endometriosis of the cervix and adhesions.
7. Suspicion of uterine myoma or fibroids.
8. Ligation, plastic surgery of fallopian tubes.
9. When emergency intervention is necessary - in case of rupture of the fallopian tubes, breakthrough internal bleeding.
10. Severe dysmenorrhea.
11. Twisting of the pedicle of an ovarian cyst.
12. Purulent infections of the pelvic organs.
13. Ovarian rupture.

Laparoscopy is well suited for collecting biomaterial from the pelvic organs if you want to know the cellular content of tissues. The operation is successfully used to treat polycystic ovary syndrome and remove a malignant or benign tumor. Using laparoscopy, adhesions, uterus, ovaries are excised, and anatomical anomalies of the internal reproductive organs are treated.

Laparoscopy is used to treat other diseases:

• ascites (accumulation of fluid in the abdominal cavity);
• peritonitis (rupture of the purulent contents of the inflamed appendix);
• development of oncology;
• acute inflammatory diseases of the gastrointestinal tract, liver and biliary tract;
• abdominal injury, ruptures, tissue injuries;
• chronic or acute appendicitis;
• umbilical hernia;
• ulcers, adhesions, intestinal obstruction.

The intervention is carried out in an emergency situation, when the cause of the disease has not been identified and the condition is critical. During the manipulation process, the source of the pathology is immediately detected and prompt treatment is carried out with tissue excision and bleeding elimination.

Contraindications to laparoscopy

Laparoscopic removal has absolute and relative limitations. In the first case, laparoscopy is completely prohibited, but in the second, a compromise can be made.

Laparoscopy cannot be performed:

• in a comatose state;
• after suffering clinical death;
• in the presence of sepsis;
• with severe bleeding disorders;
• with severe damage to the cardiovascular and respiratory systems.

1. Senile age. The health of such patients is unstable; serious chronic diseases are almost always present, including disorders of the heart and blood vessels. During the procedure, general anesthesia is performed, and a weakened body may find it difficult to tolerate. Serious consequences such as heart attack, arrhythmia or coronary artery disease are possible.
2. Morbid obesity (starting from stage 3-4). Such patients are usually prescribed planned manipulations, before which they need to lose weight. Excess fat deposits make it difficult to access internal organs. The laparoscope and other instruments are difficult to insert, and punctures of the skin and fatty tissue cause bleeding.
3. Presence of adhesions. Applies to those patients who have recently undergone standard surgery.
4. Any diseases of the respiratory or cardiovascular system, even minor ones, can worsen after surgery at any time.

If emergency intervention is required, without which there is a risk of death, all existing contraindications at the time of surgery are not taken into account.

How to prepare for laparoscopic surgery

Before the scheduled procedure, you must pass the necessary package of examinations, including:

• general and biochemical blood tests;
• Analysis of urine;
• fluorography;
• ECG;
• coagulogram;
• testing for HIV, syphilis, viral hepatitis.

An x-ray and ultrasound of the affected organ are done. All tests are taken 2 weeks before the surgery date.

A week before laparoscopy, foods that cause excess gas formation are removed from the diet. These include: legumes, cabbage, grains, carbonated water, dairy products.

Digestive enzymes are sometimes prescribed at the doctor's discretion. Anticoagulants and antiplatelet agents (warfarin, chimes, aspirin) are discontinued within a few days.

The anesthesiologist and surgeon should know about all medications taken.

Stop eating and drinking 12 hours before surgery. If you are very thirsty, you can rinse your mouth with water. A cleansing enema is performed in the evening and morning. If the patient is unable to do it, he takes special medications. Before the manipulation, hair is removed from the abdomen, and a shower is taken with disinfecting soap. You cannot go to surgery wearing lenses and jewelry.

How is laparoscopy performed?

The operation is performed by gynecological, urological and surgical specialists. The work itself takes place in several stages:

1. During the preoperative period, the anesthesiologist plans anesthesia in accordance with the characteristics of the individual patient. It is important to administer premedication, which effectively calms the patient’s nervous system. Excessive anxiety before manipulation creates additional stress on the heart and increases blood pressure, which is unacceptable.
2. Next, the patient, asleep under anesthesia, is connected to a machine that controls the functioning of the heart muscle. In addition to anesthesia, medications that have a myotropic effect are used. These remedies are necessary for muscle relaxation.
3. The endotracheal tube is connected to the ventilator.
4. For a detailed examination of the internal organs, large quantities of inert gas are pumped into the abdominal cavity. To do this, a small puncture is made near the navel, then carbon dioxide is injected with an insufflator.
5. After the abdomen has been enlarged to the required size and the intra-abdominal pressure has stabilized, the needle is removed and a trocar is installed in its place. The tube from the device is necessary for installing the laparoscope.
6. Next, trocars are inserted so that other surgical devices can be used.
7. If it is necessary to remove and crush an internal organ (uterus or tubes), a morcellator is used.
8. Titanium clips are necessary for pressing large vessels, including the aorta. The cuts are closed with surgical needles using absorbable material.
9. At the end of laparoscopy, the instruments are removed, antiseptic treatment is carried out, the tubes are removed, and the skin punctures are sutured.

To prevent peritonitis, drainage is installed so that any remaining pus or blood comes out.

How is laparoscopy performed in women?

Women are scheduled for surgery based on the date of their menstrual cycle. This rule cannot be neglected, otherwise complications may arise. The effectiveness of treatment directly depends on the phase of the cycle. The operation should not be performed during menstruation, otherwise it can cause an infection in the uterus and cause severe bleeding.

According to most gynecologists, laparoscopy is best performed immediately after ovulation. Its approximate date is the middle of the menstrual cycle.

If a woman has infertility of unknown etiology, then laparoscopy performed in the period after ovulation will help establish the causes.

Pros and cons of laparoscopy

When using this method of treatment, the body recovers in a short time. The period of hospitalization usually does not exceed 3 days from the moment of the manipulation. The number of incisions is minimal, so they heal quickly without causing severe pain or discomfort.

After laparoscopy, bleeding and other complications caused by mechanical damage rarely develop. No scars appear, so rehabilitation after laparoscopy is much faster than after abdominal surgery.

• limited working space for the surgeon to work, so difficulties may arise during the operation;
• the use of sharp objects during research or treatment, which require experience and skill, otherwise careless handling can result in damage to vital organs;
• the instruments are inserted without the help of hands, so it is difficult to assess the effort applied to the organ;
• In rare cases, the image on the monitor screen is distorted, so the perception of the picture may differ.

But do not worry about the possible disadvantages of laparoscopic manipulation. Instruments improve, and experienced specialists often work with minimally invasive operating techniques, so they have advanced surgical skills.

Many patients are nervous when surgical diagnostics are prescribed. But fears are in vain - this method most accurately establishes a diagnosis if other data is insufficient. A significant plus is that if a pathology is detected during the examination, the surgeon can immediately remove the tumor or affected organ.

Possible complications after surgery

Despite the low likelihood of serious complications, do not forget that this is a type of surgery, which means there may be certain health risks.

During laparoscopy, the following consequences are possible:

1. When an inert gas is injected into the abdominal cavity, the subcutaneous fat layer may swell. This condition is a consequence of subcutaneous emphysema. It does not require separate treatment and usually goes away after a few days.
2. As a result of the surgeon's erroneous actions, an organ or vessel may be accidentally damaged. This is fraught with severe bleeding, so urgent measures are taken to eliminate the problem.
3. Hemorrhage from the trocar hole is possible if the patient has a tendency to bleed.
4. Inaccurate removal of an infected organ often causes the wound to fester, which is aggravated by a decrease in the body's defenses. If such signs are detected, antibiotic treatment is urgently required.
5. General anesthesia negatively affects the functioning of the heart and inhibits the activity of the respiratory system, therefore, in preparation for laparoscopy, a thorough examination of the entire body is required.

According to statistics, the percentage of complications after laparoscopy does not exceed 5% in comparison with abdominal surgery.

How is the postoperative period going?

As soon as the procedure is completed, the patient wakes up in the operating room. Doctors need to assess the patient’s general condition and check reflex activity. He is then transferred to the general ward. You are allowed to stand on your feet once and no earlier than 5-6 hours from the moment of awakening. On the first day, eating is prohibited; you can only drink still water.

For a month after discharge, a special diet is prescribed that excludes the consumption of very fatty meat, fried foods, dairy products and eggs. At the same time, it is forbidden to train intensively in the gym and exhaust yourself with physical labor.

Laparoscopy is done for diagnostic and therapeutic purposes. The minimally invasive method is more acceptable for many, as it is less likely to cause complications compared to abdominal surgery.

The latest technical developments minimize the risks to the patient’s life, so the procedure is being performed more and more often.

To learn more about the treatment method, it is recommended to study other topical articles on the site.

Source: https://pechen.infox.ru/zhelchnyj-puzyr/laparoskopiya

Laparoscopy, contraindications and risk factors – Health Clinic 365, Ekaterinburg

absolute contraindications to laparoscopy .

For many years, it was believed that previous open (abdominal) surgery (laparotomy) and intestinal obstruction were contraindications to laparoscopy due to the increased risk of complications such as intestinal perforation.

However, recent studies show that among skilled surgeons such complications are less common with laparoscopy compared with laparotomy (open abdominal surgery).

In gynecological practice, the most common contraindication is hemodynamic instability (blood pressure and heart rate), for example, as a result of bleeding from a ruptured fallopian tube due to an ectopic pregnancy.

Another traditional contraindication was pregnancy. But in recent years, several large studies have confirmed the safety of using laparoscopy during pregnancy.

• Finally, controversy continues regarding the extent to which gynecologic malignancies are a contraindication to laparoscopy.
• Although there are no absolute contraindications for laparoscopy, several risk factors have been well studied.
• Risk factors for laparoscopy:

• Obesity. It is a well-known factor that increases the risk of any surgical intervention on the abdominal cavity and pelvic organs. During laparoscopy, excess weight becomes of particular importance. Weight is considered overweight if a woman’s body mass index (BMI) is more than 25 kg/m2, if the BMI is more than 30 kg/m2, then the condition is regarded as obesity of one degree or another. For women who are overweight, and even more so for those who are obese, every aspect of laparoscopy becomes more complex and potentially riskier. Placement of laparoscopic instruments becomes more complex and often requires special techniques. Bleeding from the abdominal wall may be more common because these vessels are more difficult to detect. Some intra-abdominal manipulations are more difficult to perform due to the limited surgical space between the abdominal wall and internal organs. This occurs due to increased retroperitoneal fat deposits in the pelvic area and increased bowel excursion into the surgical field. Weight loss prior to elective surgery in overweight or obese patients would be ideal. Unfortunately, significant weight loss can take years and, more often than not, is impossible. A more realistic approach is to educate patients about the increased risk associated with obesity and to limit the amount of surgery performed during laparoscopy. It is impossible to pinpoint the weight at which laparoscopic surgery is contraindicated, but it can be said that performing laparoscopy in patients weighing more than 130 kg requires significant skills on the part of both surgeons and anesthesiologists.
• Age. Another well-known risk factor is age. As the population ages, indications for laparoscopy will arise in more elderly women. Elderly patients, as a rule, have concomitant chronic diseases, which can increase the risk of complications during laparoscopic operations.

The most important risk factor in older patients is concomitant cardiovascular diseases.

The risk increases even more in women with cardiovascular disease who do not receive hormone replacement therapy after menopause.

Of particular importance is the increased sensitivity of the elderly to hypothermia, since the vast majority of patients experience some degree of hypothermia during laparoscopy. In elderly patients, even minor hypothermia can increase the risk of developing cardiac arrhythmias and prolong the recovery period.  

• Previous operations on the abdominal and pelvic organs.
• The probability of adhesions occurring after laparotomy (open abdominal surgery) reaches 20 percent or more. Adhesions usually occur between the omentum, peritoneum and/or intestinal loops. Given that laparoscopic surgery requires insertion of sharp instruments into the abdominal cavity, it is reasonable to assume that previous surgery may result in an increased risk of bowel injury. To reduce such risks, special strategies for performing laparoscopic operations in this category of patients have been developed.

Risk factors for anesthesia during laparoscopy:

• Time of last meal. It is one of the most important aspects of preparation for surgery. Considering that general anesthesia and increased intra-abdominal pressure during laparoscopy may increase the risk of regurgitation (reflux of gastric contents into the oropharynx) and aspiration (entry of this content into the pulmonary tract), it is necessary to strictly adhere to the time interval between the last meal and laparoscopy. This time interval is still vigorously debated by anesthesiologists, but general recommendations dictate that at least six hours should pass. In patients with reduced gastric emptying function (for example, diabetes mellitus caused by autonomic dysfunction), or in the presence of predisposing factors for regurgitation (for example, hiatal hernia, reflux), the time interval between food intake and the onset of anesthesia should be longer.

At the same time, in emergency situations such as ectopic pregnancy or ovarian peduncle torsion, general anesthesia and laparoscopy can be performed after special preparation at any time.

• Cardiovascular diseases. Preoperative assessment of the choice of surgical treatment method and preparation of patients for surgery and anesthesia is extremely important. During laparoscopic operations, patients with cardiovascular diseases may develop metabolic acidosis, respiratory acidosis and hypothermia, which in predisposed patients lead to cardiac arrhythmias. In addition, the risk of developing arrhythmia may increase due to bloating of the abdomen with carbon dioxide. Finally, the risk is increased in patients with congestive heart failure because cardiac output may be reduced due to decreased venous return and increased peripheral vascular resistance.
• Lung diseases. Despite the increased risk, laparoscopy is preferable to laparotomy in patients suffering from bronchopulmonary diseases. Particular attention should be paid to patients with hypercapnia (increased carbon dioxide in the blood) and decreased ventilation, which may be caused by laparoscopy.

Source: https://www.zdorovo365.ru/protivopokazaniya-i-faktory-riska-pri-laparoskopii.html