Post on 23-Dec-2015
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ColchesterLaparoscopic
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
ColchesterLaparoscopic
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
ColchesterLaparoscopic
ColchesterLaparoscopic
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
ColchesterLaparoscopic
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.
ColchesterLaparoscopic
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
ColchesterLaparoscopic
Any Questions?Any Questions?