Surgery

Biography

Biography: Dr.Abdul wahed

Abstract

Animal studies demonstrated that intraperitoneal CO2 insufflation during laparoscopic surgery increases the intraabdominal pressure and may adversely affect the oxygenation of the colon. Bowel ischaemia has been reported after various laparoscopic procedures including cholecystectomy, Nissen funduplication, incisional and inguinal hernia repair. This serious complication can also occur after minimally invasive colorectal procedures. Its occurrence is associated with high mortality rate and hence surgeons should exercise a high index of suspicion and be on the alert for this complication after laparoscopic colorectal resection. However, the question that needs to be answered is whether laparoscopic colorectal surgery is associated with higher incidence of colon ischaemia than open surgery. The following steps have been suggested to minimize its occurrence in laparoscopic procedures: 1) Avoidance of intraoperative and postoperative haemorrhage, dehydration and hypotension; 2) Avoidance of prolonged traction on the bowel during extracorporeal resection and anastomosis and hence intracorporeal resection and anastomosis is recommended; 3) Use of the lowest acceptable intraabdominal pressure as high pressure pneumoperitoneum (more than 15 mmHg) significantly impairs the intestinal tissue oxygen pressure and this may predispose to ischaemia; 4) Intermittent decompression and deflation during prolonged laparoscopic procedures and 5) Special care and precautions are taken in the elderly with cardiovascular disease. Although the incidence of this complication is rare, further studies to either confirm or refute the assumption that this complication is associated with laparoscopic more than open colorectal procedures are needed.