[Laparoscopic second-look in acute intestinal ischemia]

The early surgical reexploration to check the viability of intestinal loops in patients operated on for acute mesenteric ischaemia (the so called "second-look"), has contributed in improving the prognosis of this disease. However, since there are no certain predictive criteria for the progression of ischaemia, and not all patients are reoperated for a "second-look", some patients will undergo an unnecessary surgical and anaesthesiological procedure (negative second-look), and others, for which a surgical "second-look" might be beneficial, will not be operated on. In order to find a method which allows an effective early exploration of all patients operated for acute intestinal ischaemia, we performed a "laparoscopic second-look" on the last two patients we have operated on. They were admitted in our institution (Dipartimento di Scienze Chirurgiche e Trapianti d'organo--Divisione Chirurgia d'urgenza--Ospedale "S. Michele"--Cagliari) and had an intestinal resection for acute mesenteric ischaemia. Both had an early laparoscopic second-look under local anaesthesia, and the pneumoperitoneum was obtained with nitrous oxide insufflated through the drainage tube positioned during the surgical procedure. The exam showed normally healing anastomosis and viable intestinal loops. The consistent reduction of anaesthesiological and surgical trauma makes the "laparoscopic second-look" a routine substitute of the "surgical second-look" in all patients operated for acute mesenteric ischaemia.