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Jane Hendricks Bsc (hons)Jane Hendricks Bsc (hons)

Surgical Care Practitioner: Laparoscopic SurgerySurgical Care Practitioner: Laparoscopic Surgery

Emergency Laparoscopic SurgeryEmergency Laparoscopic Surgery

Essex Rivers Healthcare NHS TrustColchester General Hospital

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Classification of Emergency Surgery.Classification of Emergency Surgery. CEPOD definitionCEPOD definition PlannedPlanned UnplannedUnplanned Most types of elective surgery can Most types of elective surgery can

present as an emergencypresent as an emergency

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Perforated Duodenal UlcerPerforated Duodenal Ulcer

Types of surgeryTypes of surgery Suction and irrigationSuction and irrigation Omental patchOmental patch Tissue glueTissue glue

Patient positionPatient position

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Acute CholecystitisAcute Cholecystitis

Gangrenous gallbladderGangrenous gallbladder Partial cholecystectomyPartial cholecystectomy Operate in first 24-48hrsOperate in first 24-48hrs

Otherwise leave for 6 weeksOtherwise leave for 6 weeks

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ColchesterLaparoscopic

Stones in common Bile DuctStones in common Bile Duct

Not always an emergencyNot always an emergency JaundiceJaundice

ERCPERCP PancreatitisPancreatitis Need to have cholecystectomyNeed to have cholecystectomy

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ColchesterLaparoscopic

Incarcerated HerniaIncarcerated Hernia

IncisionialIncisionial InguinalInguinal FemoralFemoral Additional complication of small Additional complication of small

bowel resectionbowel resection

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Crohn’s DiseaseCrohn’s Disease

Lap ileo caec caecal resectionLap ileo caec caecal resection StricturoplastyStricturoplasty Resection after previous laparotomyResection after previous laparotomy

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Ulcerative ColitisUlcerative Colitis

Subtotal colectomy ileorectal Subtotal colectomy ileorectal anastomosis, probable loop ileostomy anastomosis, probable loop ileostomy if done under emergency if done under emergency circumstances.circumstances.

Subtotal colectomy, end ileostomy.Subtotal colectomy, end ileostomy. Place rectal stump under abdo incisionPlace rectal stump under abdo incision Return for an elective restorative Return for an elective restorative

procedure.procedure.

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Diverticular DiseaseDiverticular Disease

Perforated sigmoid colonPerforated sigmoid colon Sigmoid colectomy end to end Sigmoid colectomy end to end

anastomosisanastomosis Obstruction due to stenosis of colonObstruction due to stenosis of colon Sometimes difficult to differentiate Sometimes difficult to differentiate

between diverticular disease and between diverticular disease and carcinoma, although if perforated poor carcinoma, although if perforated poor prognosis.prognosis.

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ColchesterLaparoscopic

Carcinoma of ColonCarcinoma of Colon

Any carcinoma can cause obstructionAny carcinoma can cause obstruction Dependant on amount of dilated bowel as Dependant on amount of dilated bowel as

to success of a laparoscopic procedure.to success of a laparoscopic procedure. Resection not always operation of Resection not always operation of

choicechoice Formation of stoma and Formation of stoma and

chemo/radiotherapy and perform chemo/radiotherapy and perform resection at a later date.resection at a later date.

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Small Bowel ObstructionSmall Bowel Obstruction

Dependant on how much dilated Dependant on how much dilated bowel.bowel.

Not easy to visualise pathology, may Not easy to visualise pathology, may miss somethingmiss something

Good for band adhesion, but may be Good for band adhesion, but may be difficult to locatedifficult to locate

Obstruction due to foreign bodyObstruction due to foreign body

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Anaesthetic ConsiderationsAnaesthetic Considerations

Culture of needs an “open operation”.Culture of needs an “open operation”. Not fit for a laparoscopic procedure.Not fit for a laparoscopic procedure. Informed consent: often no provision Informed consent: often no provision

for formal preadmission.for formal preadmission. Immune response directly correlated to Immune response directly correlated to

the size of the incision.the size of the incision.

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Pneumoperitoneum, CO2 AbsorptionPneumoperitoneum, CO2 Absorption Patient positionPatient position

↑ ↑ venous return & CVPvenous return & CVP Introduction CO2Introduction CO2

hypercarbiahypercarbia Increased intra abdominal pressure.Increased intra abdominal pressure.

Affects all systemsAffects all systems

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Post Operative ConsiderationsPost Operative Considerations PONVPONV; IV fluids, ondansetron & ; IV fluids, ondansetron &

dexamethasone.dexamethasone. Shoulder tip pain / abdominal pain.Shoulder tip pain / abdominal pain.

DiclofenacDiclofenac CodydramolCodydramol

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Enhanced Recovery ProgrammeEnhanced Recovery Programme Adopt the same principles as for Adopt the same principles as for

electives, if it isn’t tolerated by patient electives, if it isn’t tolerated by patient revert to “old fashioned principles”.revert to “old fashioned principles”.

No more 30mls per hourNo more 30mls per hour

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Any Questions?Any Questions?