The abdominal drain. A convenient port for second-look laparoscopy

Abdominal reexploration may occasionally be necessary in cases of doubtful bowel viability and intra-abdominal sepsis. When this is indicated, second-look laparoscopy may be a useful alternative to conventional surgery, because it avoids subjecting an often critically ill patient to the trauma and risks of relaparotomy. Performing the laparoscopy through a cannula fitted to a flexible tube drain, inserted at the first laparotomy or laparoscopy, is proposed. The drain is withdrawn slightly, a laparoscopic cannula is inserted into the drain, pneumoperitoneum is established, and the laparoscope is then passed down the cannula and the drain for exploration. The authors considered this technique in 11 cases and report four cases in which it was used. Therapeutic laparoscopic procedures-e.g., drainage of collections, adhesiolysis, and stroma formation-were carried out in two cases, and laparotomy was required in two. This method is safe, atraumatic, and technically simple, and it can serve diagnostic as well as therapeutic purposes. The simplicity and ease of this method may encourage wider application to benefit more patients.