ROLE OF LAPAROSCOPY IN ACUTE ABDOMEN

Abstract

SUMMARY AND CONCLUSION A cute abdomen is a medical slang for sudden abdominal symptoms consists mainly of pain, and may be associated withvomiting, constipation, and changes in genitourinary function. Classically, abdominal pain is separated into three categories: visceral pain, parietalpain, and referred pain. Although neurophysiologic differences between them are slight, the distinctions possess value for understanding patterns of clinical pain. The first step of laparoscopic surgery is induction of pneumoperitoneum followed by insertion of laparoscopic instruments which consist of laparoscope which is connected to light source and video signal processor which connect it to monitor. To introduce the laparoscope to the abdominal cavity various techniques and trocares are used including Veress needle and Hasson trocar technique. Other instruments of laparoscopic surgery include graspers and staplers. Sutures are taken intra or extra-corporeal. Laparoscopy has its own complications as: 1- Reduction of cardiac output and lung compliance which obligate us to use it advertently in cardiac and pulmonary patients, 2- Pulmonary embolism, 3- Rectus sheath hematoma, 4- Higher incidence of vascular injury, 5- Iatrogenic perforation of a viscus which may go unnoticed. Laparoscopy has many applications in acute abdomen.It has a great value in diagnosis of etiology of acute abdomen, in differentiation between the causes that need exploration and the causes that need medical treatment, especially in cases that we will wait and see or investigate and see. It is used after other investigation modalities as ultrasound or CT. To use laparoscopy for therapeutic purposes in acute abdomen, it's preferred for patients having localized infection which didn't reach the diffuse peritonitis stage. Other relative contraindications are very obese patients who have much intraperitoneal fat that makes dissection difficult or delayed cases after 48 hours of the onset of acute abdomen that may have a phlegmon obscuring the field and pregnancy according to surgeon’s talent and experience. It is used in treatment of acute appendicitis, acute cholecystitis, empyema of gall bladder, mucocele of gall bladder, removal of intestinal adhesions in intestinal obstruction, perforated peptic ulcer, ectopic pregnancy, pelvic inflammatory diseases, removal of Meckel's diverticulum. It can be used in management of blunt and penetrating abdominal trauma in hemodynamically stable patients. It has many advantages when used in acute abdominal surgery such as reduction of wound size thus giving better cosmetic results of the wound, less post operative pain and thus less hospital time stay, early return of bowel function, early return to work and less post operative adhesions with less incidence of post operative intestinal obstruction. The main disadvantage of laparoscopic surgery is relatively longer operative time, higher economic cost and its need to expert surgeon.