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Laparoscopy in acute bowel obstruction following previous surgery is a difficult procedure and avoided by most of the surgeons due to the difficulty in obtaining pneumoperitoneum, port placement, lack of working space, adhesions and risk of bowel injury.
Here is a patient who had a previous laparotomy for trauma with a midline incision from xyphysternum to pubis; after unsuccessful conservative management he underwent a laparoscopy; a prior CT scan showed adhesions in the left side and a distal-mid small bowel obstruction. The pneumoperitoneum was obtained with the Visiport placed in the right lower quadrant; although the abdomen was grossly distended, under significant tension and distended loops of small bowel were occupying most the peritoneal cavity, with muscle relaxation there is usually enough space to perform a thorough inspection of the abdominal cavity. Port placement has to be done with special care as there is no room to push and usually a blunt trocar directed away from the bowel is employed in my practice. The collapsed loops of small bowel point quickly to the site of obstruction -- it is better to avoid manipulating the distended bowel as it is heavy, oedematous and prone to be lacerated with the instruments; once the pathology is identified, in this case the obstructive band, light packing is performed in order to expose the working space and protect the bowel from instruments like scissors or diathermy. In this case the band adhesion was slightly more difficult to separate from the bowel and required a combination of sharp and gentle blunt dissection.
Once the obstruction is release and the transit of contents is confirmed in the collapsed bowel the procedure is terminated. No abdominal drainage is usually necessary.
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esophago-gastro- duodinoscopy
Gastroduodinoscopy requires special training and considerable experience but affords valuable information.
By its implement the whole of the interior of the stomach as well as esophagus, the first part and the proximal section of the second part of the duodenum and both efferent and afferent loops of the gastrojujenostomy if present can be scrutinized.
Gastroscopy is valuable in the diagnosis of gastric ulcers, in checking the results of medical treatment of chronic gastric ulcer. Gastroduodinoscopy is valuable in differential diagnosis between chronic peptic ulcer and gastric carcinoma, in diagnosis of small gastric neoplasm, in the detection of certain forms of gastritis, in examination of a stoma, in cases of gastrojujenostomy, in cases of duodinitis and duodenal ulcer.
Now its' the Era of
VIDEOGASROSCOPE
Direct means of diagnosis of upper G.I. diseases
Continuous Video recording of the entire procedure is there by which
we can review the whole procedure by playing the Video.
We are doing final diagnosis of upper G.I. lesions with biopsy.
Treatment becomes easy and to the point.
Early detection of pre malignant and malignant lesions is appreciable.
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