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Emergency Laparoscopic Surgery

Emergency Laparoscopic Surgery. Jane Hendricks Bsc (hons) Surgical Care Practitioner: Laparoscopic Surgery. Essex Rivers Healthcare NHS Trust Colchester General Hospital. Classification of Emergency Surgery. CEPOD definition Planned Unplanned

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Emergency Laparoscopic Surgery

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  1. Emergency Laparoscopic Surgery Jane Hendricks Bsc (hons) Surgical Care Practitioner: Laparoscopic Surgery Essex Rivers Healthcare NHS Trust Colchester General Hospital

  2. Classification of Emergency Surgery. • CEPOD definition • Planned • Unplanned • Most types of elective surgery can present as an emergency

  3. Perforated Duodenal Ulcer • Types of surgery • Suction and irrigation • Omental patch • Tissue glue • Patient position

  4. Acute Cholecystitis • Gangrenous gallbladder • Partial cholecystectomy • Operate in first 24-48hrs • Otherwise leave for 6 weeks

  5. Stones in common Bile Duct • Not always an emergency • Jaundice • ERCP • Pancreatitis • Need to have cholecystectomy

  6. Incarcerated Hernia • Incisionial • Inguinal • Femoral • Additional complication of small bowel resection

  7. Crohn’s Disease • Lap ileo caec caecal resection • Stricturoplasty • Resection after previous laparotomy

  8. Ulcerative Colitis • Subtotal colectomy ileorectal anastomosis, probable loop ileostomy if done under emergency circumstances. • Subtotal colectomy, end ileostomy. • Place rectal stump under abdo incision • Return for an elective restorative procedure.

  9. Diverticular Disease • Perforated sigmoid colon • Sigmoid colectomy end to end anastomosis • Obstruction due to stenosis of colon • Sometimes difficult to differentiate between diverticular disease and carcinoma, although if perforated poor prognosis.

  10. Carcinoma of Colon • Any carcinoma can cause obstruction • Dependant on amount of dilated bowel as to success of a laparoscopic procedure. • Resection not always operation of choice • Formation of stoma and chemo/radiotherapy and perform resection at a later date.

  11. Small Bowel Obstruction • Dependant on how much dilated bowel. • Not easy to visualise pathology, may miss something • Good for band adhesion, but may be difficult to locate • Obstruction due to foreign body

  12. Anaesthetic Considerations • Culture of needs an “open operation”. • Not fit for a laparoscopic procedure. • Informed consent: often no provision for formal preadmission. • Immune response directly correlated to the size of the incision.

  13. Pneumoperitoneum, CO2 Absorption • Patient position • ↑ venous return & CVP • Introduction CO2 • hypercarbia • Increased intra abdominal pressure. • Affects all systems

  14. Post Operative Considerations • PONV; IV fluids, ondansetron & dexamethasone. • Shoulder tip pain / abdominal pain. • Diclofenac • Codydramol

  15. Enhanced Recovery Programme • Adopt the same principles as for electives, if it isn’t tolerated by patient revert to “old fashioned principles”. • No more 30mls per hour

  16. Any Questions?

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