Acute abdominal emergencies are diagnosed incorrectly or too late in 5 to 20% of cases. The delay in appropriate treatment, improper surgical access route and repeat surgery causes higher morbidity and mortality.
Emergency laparoscopy (keyhole) allows for both the accurate diagnosis and immediate laparoscopic treatment of many acute abdominal disorders. This is a laparoscopic image of the appendix in a 14 year old girl who had multiple hospital admissions during the preceding 8 months and despite repeated investigations no diagnosis was reached. The emergency laparoscopy revealed a tense, fibrotic appendix the legacy of repeated attacks of appendicitis. The scar-less laparoscopy diagnosed and treated the condition and the patient was discharged home the same day.
Laparoscopic (keyhole) appendicectomy is firmly established as the best intervention in acute appendicitis. These are the operative laparoscopic images of an morbidly obese 60 year old man who had an emergency admission that followed by multiple outpatient reviews for a right sided abdominal pain. All investigations inclusive of ultrasound scan and repeated CT scans did not have any firm conclusions. The emergency scar-less laparoscopy diagnosed and treated the appendicitis saving the patient a long laparotomy (a cut in the tummy) incision with the associated short and long term consequences.
Laparoscopic surgery is performed through smaller skin incisions with lesser chance of wound infection.
Scar-free surgery Professor Rasheed, a highly experienced laparoscopic (keyhole) surgeon and the lead for the Gwent keyhole surgery team, carries out scar-free surgery by operating through the navel. The technique is the latest development in ‘minimally access’ surgery. It involves making a cut in the navel which is then widened and held open while long surgical instruments are inserted and removed through the hole. The only visible sign of the operation is a small scar which is hidden by the wrinkle of the navel.
Professor Rasheed has always strived to improve the care provided to patients and to develop innovative new surgical techniques.
Frequently Asked Questions
- 1. What can be diagnosed / treated?
- The following can be diagnosed and/or treated during emergency laparoscopy:
Complicated Ovarian Cysts.
Pelvic Inflammatory Diseases.
Bedside Laparoscopy in the ICU.
Complicated Meckel’s diverticulum.
Laparoscopy for Acute Appendicitis.
Laparoscopy for Intestinal Ischemia.
Laparoscopic Management of Diverticulitis.
Laparoscopic Management of Perforated Ulcer.
Diagnostic Laparoscopy for Acute Abdominal Pain.
Laparoscopic Management of Intestinal Obstruction.
Laparoscopy for Abdominal Trauma (Blunt and Penetrating).
Laparoscopic Re-operations for Postoperative Complications.
- 2. How is emergency laparoscopy done?
- The emergency laparoscopy is done in the same way as elective laparoscopy by a specialist laparoscopic surgeon skilled at advanced therapeutic laparoscopy (able to treat the diagnosed pathology by keyhole).
- 3. What are the benefits?
- Emergency laparoscopy improves the diagnostic accuracy.
- Emergency laparoscopy reveals a clinical misdiagnosis in 41% of female of reproductive age group.
- Emergency laparoscopy enables a better evaluation of the peritoneal cavity than that obtained by the standard laparotomy.
- The procedure allows rapid and thorough inspection of the para-colic gutters and the pelvic cavity that is not possible with the open approach.
- Diagnostic and therapeutic surgery is possible at the same time.
- Less post-operative complications like wound infection, adhesion and hernias.
- Less post-operative pain.
- Short hospital stay.
- Faster recovery.
- 4. What id the recovery period?
- The recovery period after emergency laparoscopy depends on the diagnosis and the treatment received. Patients may start drinking liquids 4 hours after anaesthesia. Patients are encouraged to mobilise 4 hours after surgery. They are usually allowed home the next day and the majority go back to routine activity in 5 days and back to work in 10 days.
- 5. Emergency laparoscopy in trauma
- Emergency laparoscopy plays an important role in haemodynamically stable trauma patients with suspected peritoneal breach following a penetrating anterior abdominal wall trauma. Proving that penetration has not occurred negates the need for laparotomy. The current diagnostic modalities, including USS and CT scanning are unable to do this. Laparoscopy has been shown to be highly effective at determining peritoneal penetration, resulting in decreased laparotomy rates, length of stay and cost.