Laparoscopic Surgery of the Abdomen

Laparoscopic Surgery of the Abdomen is intended to give the practicing surgeon or trainee an in-depth analysis of the technical aspects of the most commonly.
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Before surgery, all patients undergo esophagogastro-duodenoscopy to evaluate esophagitis from reflux, hiatal hernia, stricture, or Barrett's esophagus. An esophageal motility study is performed to rule out the possibility of achalasia, which can mimic reflux disease, and to evaluate esophageal peristalsis. A hour esophageal pH probe is used when the diagnosis is in doubt. A barium swallow examination is useful in patients with large hiatal hernias, strictures, or Barrett's esophagus to help determine esophageal length.

Open surgery, performed through an upper midline incision, requires a hospital stay of at least 4—7 days, during which time the bowel begins to function as the ileus resolves. Patients generally return to work in 4—6 weeks. The laparoscopic procedure generally necessitates a single day of hospital stay; patients can generally return to light work in about 2 weeks. Patients are kept on a strict soft diet for 2 weeks postoperatively to allow swelling of the surgical area to abate. Laparoscopic fundoplication is performed through five trocar sites.

The laparoscope is placed near the umbilicus on the left side, and two trocars are placed just below the costal margin on both sides of the midline. The operation involves identification of the crura of the diaphragm and dissection around the esophagus, dissection of the short gastric vessels, and wrapping the fundus of the stomach around the esophagus. If esophageal peristalsis is normal, the wrap will be placed completely around the esophagus called a Nissen fundoplication , or, if the peristalsis is poor, the wrap will be placed only partially around the esophagus.

A partial gastric wrap puts less pressure than a full wrap on the lower esophageal sphincter and decreases the risk of the wrap causing dysphagia. A partial wrap is usually placed posteriorly around the esophagus, called a Toupet fundoplication. If the esophagus is too short, a laparoscopic esophageal lengthening procedure is performed.

Minimally Invasive Abdominal Surgery

The stomach is stapled in such a way that a tube is formed distal to the lower esophageal sphincter and the fundoplication is performed around this tube. Between January and December , we performed 96 laparoscopic fundoplications for reflux disease at Ochsner. Average hospital stay was 1. Dysphagia was experienced by 5.

One patient was readmitted and required operation for bleeding. Achalasia is a disease of the esophagus in which the lower esophageal sphincter does not relax with swallowing and there is no peristalsis. Symptoms are dysphagia and weight loss.

GIST tumour Stomach Laparoscopic Resection

There are currently three treatment options. The most important aspect of treating achalasia is performing definitive treatment as soon as possible. If treatment is delayed, the esophagus becomes dilated. Since patients with achalasia have no peristalsis, they rely on gravity to bring food boluses down the esophagus. When the esophagus becomes dilated, food tends to remain in the esophagus even after the lower esophageal sphincter is adequately opened.

If surgery has not already been attempted in a patient with a dilated esophagus, it is worth trying, but the chances that it will be effective are reduced. The next best treatment option is then esophagectomy, a much more involved procedure.

Diagnostic laparoscopy

Open surgery for achalasia is performed through an upper midline incision. Bowel function returns over 4—7 days, which is the usual length of hospital stay, and return to work is in 4—6 weeks. Laparoscopic patients spend 1—2 days in the hospital and are discharged on a full liquid diet. They are advanced to a soft diet 1 week postoperatively and then to a regular diet 2 weeks postoperatively when they may return to work on light duty. Although we have performed some minimally invasive procedures through the chest, we currently favor the abdominal approach, a modified form of an operation described by Heller in involving severing the muscle of the lower esophageal sphincter 3.

Laparoscopic Heller myotomy requires five trocar sites and is similar in many ways to laparoscopic fundoplication except that a myotomy of the lower esophageal sphincter is followed by a partial fundoplication by wrapping the fundus of the stomach posteriorly around the lower esophagus. This helps prevent reflux without an increased risk of dysphagia. By the time of the last review of our series we had performed 21 Heller myotomies, 16 of which were through the laparoscopic abdominal approach 4.

Hospital length of stay averaged 2. Hernias are often found on routine physical examination, and patients are asymptomatic on presentation to the surgeon. Unlike many other surgical procedures, hernia surgery is most often performed to prevent complications, including hernia growth, and incarceration or infarction of hernia contents and pain. Open herniorrhaphy can be performed with general, spinal, or local anesthesia with intravenous sedation and most patients leave the same day as surgery. Recovery time is 2 weeks for light duty and 4—6 weeks for heavy duty; however, surgery for bilateral and recurrent hernias requires a more prolonged recovery time.

All patients with groin hernias, including recurrent and bilateral hernias, can be considered for laparoscopic surgery, except those with prior midline lower abdominal incisions or those who cannot undergo the general anesthesia required for laparoscopic groin hernia repair. Most patients are discharged the same day as surgery and most with desk jobs can go back to work 1 week after surgery, and can increase activity after 2 weeks. A longer recuperative time, usually 4 weeks, is necessary for heavy activity. This quick recovery can be expected even after surgery for bilateral and recurrent hernias.

In the laparoscopic procedure, three trocars are placed in the midline between the navel and the pubic symphysis. Both groins can be accessed through the same trocar sites. Dissection is performed in the preperitoneal space between the peritoneum and the musculature of the abdominal wall. After the groins are dissected and the hernias reduced into the abdomen, a large patch is placed over the hernia defect and stapled in place. Laparoscopic ventral hernia repair is indicated for complicated hernias such as recurrent hernias, multiple defects in the abdominal wall, or defects that are hard to find on physical examination.

The overall cosmetic result of laparoscopic repair of an incisional hernia may not be different from open repair because of the prior incision. Discharge is usually the same day as surgery, and recovery time is shorter than for open surgical repair. Laparoscopy is performed to evaluate the size of the defect and to find the exact site of the defect to minimize scarring.

For small defects, a primary repair uses two trocar sites. For larger defects, three trocar sites are used and a large patch is stapled around its perimeter on the inside of the abdominal wall overlaying the defect and spreading well beyond the defect edges. Laparoscopic splenectomy is performed mostly for hematologic diseases such as idiopathic thrombocytopenic purpura ITP , thrombotic thrombocytopenic purpura TTP , autoimmune hemolytic anemia, and heredity spherocytosis.

Laparoscopic splenectomy is very difficult if the spleen is much enlarged.


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Open splenectomy is performed through an upper midline incision or an incision below the rib cage on the left side, a procedure requiring a 4-day hospital stay and 4—6 weeks off work. The laparoscopic procedure is performed through four trocar sites under the left costal margin. In the laparoscopic procedure, the spleen is detached from the stomach, diaphragm, colon, and retroperitoneum. The hilum is divided and the edges of a bag are brought through one of the trocar incisions.


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    8. The spleen is then removed in small pieces. Most patients are discharged the day after surgery and return to normal physical activities in 2 weeks. Adrenal disease requiring surgery is rare. Most adrenal resections are for benign lesions called adenomas that can be functional and secrete adrenal hormones such as aldosterone which causes hypertension primary hyperaldosteronism.

    Other lesions are removed because their size, growth, or appearance on CAT scan suggests the possibility of adrenal cancer. Laparoscopic adrenalectomy is indicated for any adrenal lesion less than 10 cm. Both the right and left adrenal glands are easily resected laparoscopically, and bilateral adrenalectomy can also be performed. We perform laparoscopic adrenalectomy through the flank on the side of the lesion with three to four trocars placed just below the costal margin.

    Diagnostic laparoscopy: MedlinePlus Medical Encyclopedia

    On the left side, the spleen is freed from its lateral attachments and brought medially, and, once the adrenal gland is identified in the retroperitoneum, the adrenal vein is ligated and divided. The gland is then separated from the surrounding tissue, placed in a visceral bag, and removed from the abdomen. On the right side, the liver edge is lifted up to reveal the posterior edge of the liver.

    The peritoneum is incised along the posterior edge of the liver from lateral to medial until the inferior vena and the incision is brought along the inferior vena cava caudad. The adrenal vein is found along the lateral border of the inferior vena cava, ligated, and divided.

    Gallbladder Diseases and Common Bile Duct Stones

    The gland is identified, freed from the surrounding tissue, placed in a visceral bag, and removed from the abdomen. In a recent review of our experience with laparoscopic and open surgery for primary hyperaldosteronism 5 , 10 procedures were performed open and 14 laparoscopically; the size of the lesions was similar in both groups. Four of the laparoscopic cases were converted to open surgery early on, but none since we adopted the technique described above. Unlike most laparoscopic procedures, operative time and response to surgery were similar to those for open surgery; however, blood loss and complications were less in the laparoscopic group.

    For open adrenalectomy patients, hospital length of stay was twice that of the laparoscopic group 6. Laparoscopic appendectomy, which has several advantages over open appendectomy, is indicated whenever appendicitis is suspected. Although the recovery time is shorter than for open appendectomy, the length of hospital stay is nearly the same. The gas used during the procedure can irritate the diaphragm, which shares some of the same nerves as the shoulder. You may also have an increased urge to urinate, since the gas can put pressure on the bladder.

    You will recover for a few hours at the hospital before going home. You will probably not stay overnight after a laparoscopy. You will not be allowed to drive home.

    How the Test is Performed

    Someone should be available to pick you up after the procedure. The laparoscopy is normal if there is no blood in the abdomen, no hernias, no intestinal obstruction, and no cancer in any visible organs. The uterus, fallopian tubes, and ovaries are of normal size, shape, and color.

    The liver is normal.

    What is a laparoscopy?

    There is a risk of puncturing an organ. This could cause the contents of the intestines to leak. There may also be bleeding into the abdominal cavity. These complications could lead to immediate open surgery laparotomy. Diagnostic laparoscopy may not be possible if you have a swollen bowel, fluid in the abdomen ascites , or you have had a past surgery. Falcone T, Walters MD. Atlas of Pelvic Anatomy and Gynecologic Surgery. Staging laparoscopy for gastrointestinal cancer. Review provided by VeriMed Healthcare Network. How the Test is Performed. The procedure is performed in the following way: The surgeon makes a small cut incision below the belly button.

    A needle or tube is inserted into the incision. Carbon dioxide gas is passed into the abdomen through the needle or tube. The gas helps expand the area, giving the surgeon more room to work, and helps the surgeon see the organs more clearly. A tube is placed through the cut in your abdomen.


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    A tiny video camera laparoscope goes through this tube and is used to see the inside of your pelvis and abdomen. More small cuts may be made if other instruments are needed to get a better view of certain organs.