Laparoscopic Exploratory Surgery Exploratory laparoscopy has often been used for

diagnostic purposes to view the abdomen after abdominal trauma and in cases of
abdominal illness. Laparoscopy is a term given to a group of operations that are
performed with the aid of a camera placed in the abdomen. Originally, the lapar
oscope was used during surgical removal of the gallbladder (laparoscopic cholecy
stectomy) and appendix (laparoscopic appendectomy). Now the laparoscope also all
ows physicians to perform minimally invasive surgery with just a small incision
in the abdomen. This technology, known as laparoscopic assisted surgery, enables
the minimally invasive removal of the colon, and the weight reducing procedure
gastric bypass. The procedure is usually done in the hospital, under general ane
sthesia, and after informed consent has been obtained. A catheter (a small flexi
ble tube) is inserted through the urethra into the bladder. An additional tube m
ay be passed through the nostril and into the stomach to remove intestinal conte
nts (N-G tube). The skin of the abdomen is cleansed, and sterile drapes are appl
ied. A small incision is made above or below the navel to allow the insertion of
a trocar (essentially a tube extending from inside the abdomen to the outside),
which allows passage of a video camera. Prior to insertion of the trocar, a nee
dle is inserted into the incision and carbon dioxide gas is injected to elevate
the abdominal wall, and thereby create a larger space to
work in. This allows for easier viewing and manipulation of the organs. After an
adequate amount of gas is instilled, the laparoscope is inserted, and the organ
s of the pelvis and abdomen are examined. Additional small incisions are made fo
r instruments that allow the surgeon to move the abdominal organs, cut tissue, s
uture, and staple structures to safely and effectively perform the necessary pro
cedure. Following the examination, the laparoscope is then removed, the incision
s are closed with sutures, and bandages are applied. Depending upon the operatio
n performed, a drain may be left through one of the incisions to allow for remov
al of accumulated fluid. Laparoscopy is a minimally invasive surgical procedure.
After making small incisions while the patient is asleep and under the effects
of anesthesia, the doctors use small scopes and specially designed tools to perf
orm the surgery, which includes exploratory, appendix, hernia, gallbaldder, colo
n and hiatal hernia procedures. The colon is a part of the digestive system. A h
ealthy colon helps form the solid stool that is later expelled by the body. But
growths or inflammation within the colon can cause colon problem which prevents
the colon from working properly. Thus, the infected part of the colon needs to b
e removed. Part or all of the colon can be removed laparoscopically without caus
ing serious health concerns. Surgeries remove the affected piece in a process ca
lled a resection. Then the two ends are stapled together, which is called anasto
mosis.
If the affected part is cancerous, this surgery removes the cancer and some of t
he surrounding tissue and lymph glands to help reduce the chance of a recurrence
. The surgeon preserves the colon's tubelike shape, allowing waste to pass throu
gh it easily, and retain normal bowel function. Some common colon problems inclu
de: Polyps, which are tissue growth in the colon linings. If caught early, they
frequently are not cancerous, but as they grow larger it becomes more likely the
y will become cancerous. Thus, removing the polyp early may decrease the risk of
colon cancer. Diverticulosis and Diverticulitis are two other related colon con
ditions. Diverticulosis occurs when small pouches form on the lining of the colo
n. Diverticulitis occurs when one of these pouches becomes infected and inflamed
. In some cases, the pouch also may break. Inflammatory bowel disease (IBD) is a
condition that causes swelling, inflammation, and sores in the digestive system
. Patients with untreated IBD may be at higher risk of colon cancer.
Overview & Description
An abdominal exploration, or laparotomy, is a surgical procedure that allows a s
urgeon to look inside the abdominal cavity.
Who is a candidate for the procedure?
An exploratory laparotomy is often done when a person complains of abdominal pai
n. It can also be performed after an injury to the abdomen. The operation allows
the surgeon to examine internal organs. Disease or damage
can be uncovered. In some cases, the problem can be corrected during the surgery
.
How is the procedure performed?
There are two methods for performing an abdominal exploration: Laparoscopy. In
this procedure, the surgeon uses a camera on the end of a long tube, called a l
aparoscope. The laparoscope is inserted through a small incision in the abdomen.
Laparotomy. This is a surgical procedure in which a large incision is made in
the abdomen to view the interior directly. Both procedures require general anes
thesia. A medicine is given to put the person to sleep. A tube is inserted throu
gh the person's mouth. This is connected to a ventilator, or artificial breathin
g machine. Once the person is asleep, the surgeon begins the procedure. He or sh
e makes a cut in the skin and enters the abdomen. A large cut is made for a lapa
rotomy. This allows the surgeon to view the organs directly. In a laparoscopy, t
he surgeon makes several small skin incisions in different parts of the abdomen.
A thin tube with a light and camera on the end of it is inserted through one of
the small cuts. This allows the surgeon to see the inside of the abdomen. Surgi
cal tools are inserted through the other incisions. This lets the surgeon move o
r cut tissues when needed. In both procedures, the surgeon looks at the abdomina
l organs. These include the intestines, liver, stomach, spleen, and pancreas. If
a problem is spotted, the surgeon will often try to fix it at that time.
Preparation & Expectations
What happens right after the procedure?
After the operation is over, the person will be taken to the recovery room. It i
s common for the individual to feel nauseated. There may be discomfort from the
incision. Pain is usually greater after a laparotomy. The doctor will prescribe
medicines to reduce the nausea and discomfort. After the anesthesia has worn off
, the person will return to his or her hospital room to recover. With a laparosc
opy, the person can sometimes go home on the same day as the procedure.
Home Care and Complications
What happens later at home?
After the procedure, the individual's surgeon will provide specific instructions
for recovery at home. Pain medicines are often needed for a few days. The perso
n should slowly increase his or her activity level. He or she should return to a
normal diet as soon as it is tolerated. The length of the recovery time needed
will depend on which procedure was performed. People undergoing a laparoscopy wi
ll be back to their normal activities much sooner. Recovery will also be affecte
d by any problems that were found during the surgery.
What are the potential complications after the procedure?
Surgery can cause bleeding, infection, or allergic reaction to anesthesia. Any n
ew or worsening symptoms should be reported to the healthcare provider.
Diagnostic Laparoscopy Versus Exploratory Laparotomy
Dr. Walid Sharaf Abdulla Abdulrahman; Prof. Dr. R. K. Mishra
Projected to be submitted towards completion of Combined Course of Fellowship an
d Diploma in Minimal Access Surgery, World Laparoscopy Hospital, New Delhi, Indi
a.
ABSTRACT: Diagnostic laparoscopy is a minimally invasive surgical procedure that
allows the visual examination and documentation of intra abdominal organs in or
der o detect any pathology. Diagnostic laparoscopy was first introduced in 1901,
when kelling, performed a peritoneoscopy in a dog and was called “Celioscopy”.
A Swedish internist named Jacobaeuse its credited with performing the first Diag
nostic laparoscopy on human in 1910. He described its application in patient wit
h ascites and for the early diagnosis of malignant lesion. Elective diagnosis la
paroscopy refers to the use of the procedure in chronic intra-abdominal disorder
s. Emergency diagnostic laparoscopy is performed in patients presenting with acu
te abdomen. This document describe compare the diagnostic laparoscopy with explo
ratory laparotomy. Diagnostic laparoscopy is safe well tolerated and can be perf
ormed in an outpatient and inpatient setting under general anaesthesia. KEY WORD
S: Diagnostic Laparoscopy, Acute Appendicitis, Abdominal lymphoma, Primary and S
econdary Malignancies, Gastric Cancer, Pancreatic Head Mass, Minimally Invasive
Surgery in Pediatric Cancer Patients, Evaluation of Viral
Hepatitis Patient with Potentially Resectable Hepatocellular Carcinoma, Duodenal
Perforation, Acute Peritonitis, Sickles Cell Disease, Abdominal Trauma, Gynecol
ogical, Torted Ovarian Cysts, Ectopic Pregnancy, AIMS: The aim of this study was
to compare the effectiveness an safety of Diagnostic laparoscopy and in compari
son with the exploratory laparotomy. Following parameters were evaluated for bot
h Diagnostic laparoscopic and exploratory laparotomy. 1) 2) 3) 4) 5) 6) 7) 8) 9)
Method of patient selection. Operative technique. Operating time. Intra Operati
ve complication. and post Operative
Postoperative pain and amount of narcotics used. Time until resumption of diet.
Post operative morbidity. Hospital stay. Cost effectiveness
10) Quality of life analysis. MATERIAL AND METHODS: A literature search was perf
ormed using search engine Google, Pubmed, High Wire, Online Springer library fac
ility available at The World Laparoscopy Hospital, New Delhi, India. Selected pa
pers were screened for further references CONTENTS:
The first step in diagnostics laparoscopy is through a systemic approach to expl
oration is essential to ensure that nothing is missed. At the time of diagnostic
s laparoscopy all the abdominal organs are inspected for any gross anatomical ab
normalities. If there is fluid is present samples are taken for lab. Test. ACUTE
APPENDICITIS: Laparoscopy is the only diagnostic procedure other than formal la
parotomy that allows direct visualization of the appendix. The entire appendix m
ust be seen before the operator can conclude it is normal (free of disease) feas
ibility of laparoscopy in obese patients and those with previous abdominal opera
tion depend on the surgeon experience with the procedure. Diagnostics laparoscop
y is most useful for female patient, since a gynecologic cause of symptoms is id
entified in approximately 10% to 20% of women with suspicion of appendicitis. Th
e procedure begins with diagnostics laparoscopy and continues with appendectomy
if appropriate. This benefits is greater for women, who have higher negative app
endectomy rate, and in whom laparoscopy often reveals other pathology. Explorato
ry laparotomy for diagnosis appendicitis is rarely used [1] [3] [4] [5] [6]. ABD
OMINAL LYMPHOMA: The medical records of patients with suspected primary or recur
rent lymphoma who underwent laparoscopy between March 1991 and March 2003 were r
eviewed. Demographic, clinical, operative, and pathologic data were collected. T
he feasibility, safety and effectiveness of the laparoscopic procedure were asse
ssed. Laparoscopic lymph node biopsy safely provides
adequate tissue for full histological evaluation on outpatient basis in most pat
ients with intra-abdominal lymphoma. Laparoscopy biopsy was attempted in 94 pati
ents. In 21 patients (22%), the procedure was performed in those with a prior di
agnosis of lymphoma for presumed intra-abdominal relapse and in 73 patients (78%
) to establish a new diagnosis of lymphoma. The study of population include 47 m
en (50%) and 47 women (50%). The median patient age was 60 yrs operative of the
94 patient, 22 (23%) had a history of previous abdominal or pelvic operation [8]
[9] [10]. Two cannulas were used in 21 operation (22%), 3 cannulas in 51 (54%)
and 4 cannulas in 22(23%). The procedure was completed laparoscopically in 78 pa
tients (83%). The median operating time was 31 minutes (rang, 7-94 min). during
the laparoscopic procedure biopsy specimens were obtained from the following lym
ph node site : 48 mesentic lymph nodes (51%), 12 masses not otherwise specified
but located mostly at the me sentence root (13%), 7 paraortic lymph nodes (7%),
and retro peritoneal lymph node (6%) and miscellaneous site. After laparoscopic
biopsy was performed in 36 patients who underwent preoperative core needle biops
y, 28 patient (78%) were definitively diagnosed as having malignant lymphoma wit
h complete typing in all patient, 2 (6%) had an adeno carcinoma, 1 (3%) had an e
pitheloid leomyo sarcoma and 5 (14%) had benign adenopathy [11] [12] [13] [14].
PRIMARY AND SECONDARY MALIGNANCIES:
Diagnostics laparoscopy combined with laparoscopic ultra sonography is an adequa
te staging modality for primary liver malignancies for colorectal liver metastas
is, more liberal resection criteria, a high failure rate due to adhesion from pr
evious surgery, and better preoperative probably result in a lower efficacy [15]
. Laparoscopy with laparoscopic USG avoids unnecessary exploratory laparotomy in
patients with HCC [25]. GASTRIC CANCER: Peritoneal seeding or liver metastases
found at laparotomy usually preclude curative treatment in patients with gastric
Aden carcinoma. Such exploratory laparotomy may be avoided by diagnostic laparo
scopy. One hundred and twenty consecutive patient with primary gastric Adenocarc
inoma were studied prospectively diagnostic laparoscopy was performed in patient
with clinical T4 tumors or suspected metastases, unless laparotomy was required
for symptomatic disease . Diagnostic laparoscopy in selected patients effective
ly limits the number of unnecessary invasive staging procedures. Routine use of
diagnostics laparoscopy in all patients with gastric Adenocarcinoma is not warra
nted [26]. PANCREATIC HEAD MASS: Laparoscopy has its role in diagnosis, in histo
logical confirmation, in staging, and, in certain situations, in therapy. Laparo
scopy enables us to examine the serosal surfaces of the anterior abdominal wall
diaphragm, falciform ligament, omentum, pelvic viscera, bowels and their mesente
ries. We can insufflate and enter the lesser sac and mobilize the
head of the pancreas. Particular attention is directed toward the pelvis, as it
is often the site of the earliest metastatic disease due its gravitational depen
dence. Anatomic survey of the liver, biliary tree, pancreas and peripancreatic s
tructures is mandatory. However, by itself, it does not assessing non-resectabil
ity (T stage) compared with US (100% vs. 64%; P< 0.05) and CT (100% vs. 47%; P<
0.005) . No imaging investigation is able to assess the N stage accurately. Noda
l enlargement is frequently the result of reactive hyperplasia and smaller nodes
may harbour micro metastasis. Nodal malignancy requires biopsy confirmation. In
M stage, laparoscopy with LUS is significantly more sensitive than US (94% vs.
29%; P< 0.001) and CT (94% vs. 33%; P< 0.005) . Because laparoscopy with LUS is
the most reliable method for verifying metastatic changes, it reliably predicts
tumor non-resectability [30]. For benign lesions - such as pancreatic insulinoma
,- LUS is one of the most sensitive tools available. Its detection rate is 83-10
0% [31]. All non-resectable patients could be found with the combination of BUS
plus laparoscopy plus LUS [32]. Laparoscopy with L US should be considered to be
the first step in any potentially curative surgical procedure [32]. PEDIATRIC C
ANCER PATIENTS: MIS in children is a rapidly expanding field with many diagnosti
c and therapeutic indications, with utility not only as an adjuvant for patients
undergoing cancer therapy, but also as a primary treatment of malignancy. Lapar
oscopy have been well described and have been proven effective in the treatment
of
many nonmalignant states, including appendectomy, Fundoplication, cholecystectom
y, location of non palpable testes, and laparoscopic pull-through for Hirschspru
ng's disease and imperforate anus. Although its potential utility in the adult p
opulation continues to be described for the treatment of colon, gastric, and ova
rian cancers, data are lacking concerning solid tumor resection in the pediatric
population. Despite this, sufficient evidence that MIS can be an effective appr
oach to the biopsy of solid tumors for tissue diagnosis, determination of resect
ability and staging, evaluation of metastatic or recurrent disease, secondlook o
perations, and diagnosis of infectious complications Solid-tumor resection is no
t yet supported in most cases. The purpose of this retrospective review was to e
valuate the 5-year experience at a single institution with. MlS in children with
malignancy. The biopsy of an intra-abdominal mass in a child is an important in
itial step in the multimodality approach to many pediatric solid tumors. MIS all
ows direct visualization of the tissue, visualizes hemostasis, and reveals more
anatomical details. Combined with the fact that many of these children will perh
aps be undergoing multiple procedures, MIS theoretically allows for minimal infl
ammation, fewer adhesions, decreased pain, and quicker recovery, facilitating" s
ubsequent initiation of chemotherapy and second-look or delayed primary surgery
Most of these data are extrapolated from adult studies and a few small series in
children, identifying the need for more data in the pediatric population.
Pediatric malignancies are often sensitive to chemotherapy and require only init
ial tissue biopsy for diagnosis as part of a multidisciplinary approach to their
treatment. Excellent results in diagnostic accuracy with laparoscopic biopsy te
chniques have been reported for a variety of malignancies. Points of debate stil
l revolve around the excision of solid organ malignancies, with the potential fo
r tumor spill and port-site recurrences. In addition, questions have been raised
concerning the potential alteration of the pathologic margins and the subsequen
t impairment of appropriate histological evaluation of tumor specimens after mor
cellation [33]. EVALUATION OF VIRAL HEPATITIS PATIENT WITH POTENTIALLY RESECTABL
E HEPATOCELLULAR CARCINOMA. Despite significant recent improvements in liver ima
ging, preoperative evaluation of the potentially resectable patient with viral h
epatitis and hepatocellular carcinoma (HCC) is often inaccurate. Diagnostics lap
aroscopy may change management for patients with under appreciated nodular cirrh
osis or intra hepatic metastases, preventing unnecessary open exploration. The p
urpose is to determine the effectiveness of routine laparoscopy as a separate pr
ocedure prior to resection in the evaluation of patients with potentially resect
able. (HCC) Patient with potentially resectable Hcc were evaluated preoperativel
y with routine blood test and axial imaging. All study patients also underwent d
iagnostic laparoscopy with laparoscopic ultra sonography. Laparoscopy was perfor
med in an inpatient hospital
setting with 23 hrs stay in most cases. Among 65 patients evaluated with hepatoc
ellular carcinoma between Jul, 2001 and Nov 2003, 20 patients with potentially r
esectable disease were evaluated by diagnostic laparoscopy. All patients had vir
al hepatitis; 16 with hepatitis B and 4 hepatitis C. All study patients had cirr
hosis, 18 classified as child’s Pugh A and 2 as child’s Pugh B. Diagnostic lapar
oscopy changed the management in 9/20 (45%) cases. Management was changed becaus
e of sever modular cirrhosis in 4 cases, inaccurate assessment of intrahepatic m
etastasis in 2 cases, inability to identify an HCC in 1case, peritoneal carcinom
atosis in 1 case, and inability to tolerate induction to general anesthesia in 1
case. Diagnostic laparoscopy is useful in the evaluation of the potentially res
ectable patients with HCC information obtained from laparoscopy may change the c
linical management in up to 45% of cases [34]. DUODENAL PERFORATION: Perforation
is a life threatening complication of peptic ulcer disease. Duodenal Perforatio
n is a common complication of duodenal ulcer. Perforation duodenal ulcer is main
ly a disease of young men but because of increasing smoking, use NSAID majority
of patient of perforated duodenal ulcer are H-Pylorii positive. Perforated duode
nal ulcer is a surgical emergency. Diagnostics laparoscopy is a useful method fo
r diagnostic and repair duodenal perforation [23] [24]. ACUTE PERITONITIS: The p
resence of peritonitis has previously been considered to be a contraindication f
or the laparoscopy approach because of the theoretical risk of malignant
hypercapania and toxic shock syndrome. The aim of this retrospective to demonstr
ate that laparoscopy is feasible, safe and efficient in cases of peritonitis. Fr
om Jan. 1990 to Jul. 1993, 231 patients had a laparoscopy for acute peritonitis
in two centers (91) appendicular peritonitis, 69 gastro duodenal perforated ulce
r, 35 perforation of the colon, 36 miscellaneous. The diagnostic accuracy of lap
aroscopy exploration was 84.8%. the clinical preoperative diagnosis was changed
by laparoscopic exploration I n29.1% of patients. An unnecessary laparotomy was
avoided in 6.5% of patients and the site of traditional incision was modified in
8.7%. convertion rates were 25% for appendicular peritonitis, 16% for gastro du
odenal perforation and 83% (24 of 35 patients) for colonic perforation. The over
all mortality rate was 3.9%. no malignant hypercapnia occurred [27] [28] [29].
SICKLE CELL DISEASE: Diagnostics laparoscopy has clean benefit over exploratory
laparotomy inpatient with sickle disease. Patient with acute appendicitis will c
ertainly require surgery that may be associated with high morbidity and mortalit
y as a result of pre-operative and postoperative complication, mainly vas-occlus
ive crises (voc). The D.L is believed to be associated with minimal risks to the
patient due to its numerous advantages over conventional method. The morbidity
associated with surgery in sickle cell patient can be further reduced by use of
preoperative exchange transfusion and adequate maintenance of hydration in the p
atient with sickle cell disease [2]. ABDOMINAL TRAUMA:
Laparoscopy was first used for a trauma patient in 1956 by lamy, who observed tw
o cases of Splenic injury. Since then, Gazzaniga et al. noted that laparoscopy i
s useful for determining the need for laparotomy. In 1991, Berciet al. reported
that he had reduced the number of non-therapeutic laparotomy performed for hemop
eritoneum by 25% through the use of laparoscopy 150 patients with blunt abdomina
l trauma. Laparoscopic techniques are beginning used with greater frequency for
the diagnosis and management of traumatic injuries. Although laparoscopy is an o
perative intervention, it has a role in limiting the for a full laparotomy in so
me patients with gunshot injury and stab wound. The procedure allows examination
of the anterior intra-abdominal structures in animally invasive fashion. It has
a potential advantage over standard open laparotomy in that the incision are sm
aller, allowing quicker recovery time less pain, and shorter postoperative hospi
tal stays. The limitation are that the entire abdominal cavity, especially the r
etro peritoneum and posterior diaphragm, can’t be adequately visualized with the
laparoscope and stubble injuries to the small and large bowel can easily be mis
sed. In a retrospective, multicenter study from three institutions with expertis
e in laparoscopy for trauma, the records of 510 patients undergoing the procedur
e of the initial evaluation for penetrating abdominal trauma were reviewed. Of t
heses, 194 were for gunshot wounds, and the remainders were stab wound. Laparosc
opy assisted in determining the absence of peritoneal penetration in 113 (58%) g
unshot wounds. Exploration performed on the remaining 81 gunshot wounds it perit
oneal
penetration resulted in only is non-therapeutic exploration, the most frequent s
ites of the injury begin the diaphragm, liver, and spleen [16] [17] [18]. BLUNT
TRAUMA: The utility of diagnostic laparoscopy is developing field. When performe
d in carefully selected hemo dynamically stable patients, laparoscopy is safe an
d technically feasible, chot et al reported reduced negative and non therapeutic
laparotomy rates in this identified population [19]. PENETRATING TRAUMA: Diagno
stic laparoscopy for the evaluation of penetrating trauma is more defined in tho
racic abdominal stab wounds; laparoscopy may aid in the diagnosis of diaphragmat
ic and other intra abdominal injuries, thus avoiding non therapeutic laparotomie
s. Gunshot wound to the anterior abdomen with questionable tangential trajectory
similar may be assessed. The argument is that even of there are no clinical sig
ns of intra abdominal injuries, the disadvantages associated with an unnecessary
laparotomy are minor compared to the danger of peritonitis in cases of delayed
diagnosis of intestinal perforation. An alternative to these extremes is laparos
copy which allows the inspection of the peritoneum for sign of perforation and f
urther more, in selected case, the treatment of intra-abdominal injuries [20] [2
1] [22]. OVARIAN CYST: Ovarian cysts are sac filled with fluid or a semisolid ma
terial that develops on or with the ovary. If the
growth is larger than 10 cm, complex growing persistent solid and irregularly sh
aped, on both ovaries, causes pain or other symptoms. diagnostics laparoscopy ma
nagement ovarian cyst depends on the patient age, pelvic examination, sonographi
c images, and serve markers. A large, solid fired or irregular adenexal mass acc
ompanied by ascites is suspicious for malignancy [7]. ECTOPIC PREGNANCY: Diagnos
tic laparoscopy is one of the major advancement for tubal and uterine disease. E
ctopic Pregnancy usually occurs of cases on the uterine tube. It can be found in
:1. 2. 3. The Ampulla (64%) The Isthumus (25%) The Infundibulum(09%)
Laparoscopic surgery is a good option for rupture ectopic. If the patient is hem
o dynamically stable and initial Diagnostic laparoscopy indicates a moderate blo
od loss, it may be possible to control bleeding laparoscopic ally and perform an
y indicated procedure [7]. CONTRAINDICATION: 1) 2) 3) 4) 5) Hemodynamic Instabil
ity Mechanical or Paralytic Ileus. Uncorrected Coagulopathy Generalized Peritoni
tis. Sever Cardiopulmonary Diseases.
6) 7) 8)
Abdominal Wall Infection Multiple Previous Abdominal Procedures. Late Pregnancy.
CONCLUSION: Diagnostic laparoscopy is one of the very important methods of inves
tigation for patients in whom the diagnosis or extent of the disease is unclear
or the abdominal finding are equivocal it can be performed safely in an inpatien
t or outpatient setting, potentially expediting diagnosis and treatment. Diagnos
tic laparoscopy in the most commonly performed surgical and gynecological proced
ure. Its greatest advantage is that it has replaced exploratory laparotomy.
Exploratory Laparoscopy
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WHAT YOU SHOULD KNOW: Exploratory laparoscopy (lap-ah-ROS-koh-pee) is surgery to
look at the organs inside your abdomen. Examples of these organs are the stomac
h, small and large intestines, liver and uterus (in women). During laparoscopy,
caregivers may look for causes of pain, abnormal growths, bleeding, or disease i
n your abdomen. Caregivers may also find and fix problems in your abdomen. For e
xample, caregivers may fix a hernia or
remove adhesions (scar tissue) from your organs and tissue. They may fix blocked
or damaged organs, or take tissue samples.
CARE AGREEMENT: You have the right to help plan your care. To help with this pla
n, you must learn about your health condition and how it may be treated. You can
then discuss treatment options with your caregivers. Work with them to decide w
hat care may be used to treat you. You always have the right to refuse treatment
. RISKS:
• There are always risks with surgery. You may bleed more than usual or get an i
nfection. You could have trouble breathing or get blood clots. A special gas is
used to make your abdomen bigger and easier to see inside during surgery. You ma
y have shoulder pain from this gas for a few days. If you have many adhesions, t
oo much bleeding, or other problems, you may need open surgery.
•
There is a small chance that the tools used during your surgery could touch near
by organs or tissues causing a burn. Also, organs or tissues close by could acci
dentally
have a hole made in them by the tools used during your surgery. Caregivers will
watch you closely for early signs of these problems. Call your caregiver if you
are worried or have questions about your medicine or care.
GETTING READY: The week before your surgery:
• Talk to your caregiver about over-the-counter medicine such as aspirin. You ma
y need to stop using certain medicines for a time before your laparoscopy. If yo
ur caregiver has told you to take aspirin daily, do not stop without asking firs
t. • Tell your caregiver about any over-the-counter vitamins, herbs, food supple
ments, or laxatives you are using. These medicines may not work well with medici
nes you may need during surgery.
•
You may need to have blood tests, x-rays, and other tests before surgery. Ask yo
ur caregiver for more information about these and other tests that you may need.
Write down the date, time, and location of each test.
• Take any medicine that your caregiver has given you to take before surgery exa
ctly as ordered. • Arrange to have a family member or friend to drive you home w
hen you leave the hospital. Do not drive yourself home. • Your caregiver may wan
t you to empty and clean out your bowel or other body organs before surgery. Doi
ng this may stop your bowel from getting infected after surgery. Your caregiver
may ask you to do one or more of the following things:
○ Eat high fiber foods for 1 to 2 days before surgery. Good examples of high fib
er foods are fruits, vegetables, and whole-wheat cereals and breads. Drink 6 to
8 (eight-ounce) cups of healthy liquids each day, unless your caregiver tells yo
u not to. ○ Take a special medicine called a cathartic the day before surgery. A
cathartic will make you have diarrhea (loose, watery stools), but it will clean
out your bowel quickly.
The night before your surgery:
• Try to get enough restful sleep the night before your surgery. You may be give
n a pill to help you sleep. • If you have diabetes, ask your caregiver for speci
al instructions about what you may eat and drink before your surgery. If you use
medicine to treat diabetes, your caregiver may have special instructions about
using it before surgery. You may need to check your blood sugar more often befor
e and after having surgery. • Ask caregivers about directions for eating and dri
nking.
The day of your surgery:
• Write down the correct date, time, and location of your surgery. • Wear loose,
comfortable clothing to the hospital. • Ask your caregiver before taking any me
dicine on the day of surgery. These medicines include insulin, diabetic pills, b
lood pressure pills, and heart pills. Bring a list of your medicines or the pill
bottles with you to the hospital. • Do not wear contact lenses on the day of th
e procedure. You may wear glasses.
• An anesthesiologist will talk to you before your surgery. This caregiver will
give you medicine to make you sleep during surgery. • You or a close family memb
er may be asked to sign a legal piece of paper (consent form). It gives your car
egiver permission to do surgery. It also explains the problems that may happen w
ith your surgery, and your choices. Be sure all your questions have been answere
d before you sign this form.
TREATMENT: What will happen:
• You will be asked to change into a hospital gown. You may be given medicine in
your IV to help you relax or make you drowsy. You will be taken on a cart to th
e operating room and then moved from the cart to a special bed. You will get med
icine called anesthesia to prevent pain and keep you comfortable during surgery.
• Caregivers will clean your abdomen with soap and water. This soap may make yo
ur skin yellow, but it will be cleaned off later. Sheets will be put over you to
keep the surgery area clean. A laparoscope and other tools will be put into 3 o
r 4 small incisions (cuts) made in your abdomen. After your operation is finishe
d, your incisions are closed with stitches (thread) or staples. Adhesive strips
or bandages may also be put over the incisions. It is normal to have skin bruisi
ng at the incision sites. The bruising should fade away in about a week.
After surgery: You will be taken to a room where you can rest until you wake up.
You may be allowed to go home. If you are staying in the hospital, you will be
taken back to your room. Do not get out of bed until your caregiver says it is O
K. A bandage is used to cover your
stitches or staples. This bandage keeps the area clean and dry to prevent infect
ion. A caregiver may remove the bandage soon after surgery to check your incisio
n. Waiting room: This is a room where your family and friends can wait until you
are ready for visitors. If your family leaves the hospital, ask them to leave a
phone number where they can be reached. CONTACT A CAREGIVER IF:
• You have questions or concerns about your surgery. • You have a fever (increas
ed body temperature). • You cannot make it to your surgery on time. • The proble
ms for which you are having surgery get worse.
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End User s use only and may not be sold, redistributed or otherwise used for co
mmercial purposes. The above information is an educational aid only. It is not i
ntended as medical advice for individual conditions or treatments. Talk to your
doctor, nurse or pharmacist before following any medical regimen to see if it is
safe and effective for you.