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Laparoscopy in the critically ill

R Orlando1, K L Crowell

  • 1Department of Surgery, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102-5037, USA, and University of Connecticut School of Medicine, Farmington, CT 06034, USA.

Surgical Endoscopy
|November 1, 1997
PubMed
Summary

Laparoscopy is safe and effective for critically ill patients with suspected abdominal sepsis. This minimally invasive procedure aids diagnosis and treatment of conditions like acute cholecystitis and mesenteric ischemia.

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Area of Science:

  • Surgical critical care
  • Minimally invasive surgery
  • Gastrointestinal diagnostics

Background:

  • Critically ill patients with suspected abdominal sepsis pose diagnostic challenges.
  • Conditions evaluated include acute cholecystitis, mesenteric ischemia, and gastrointestinal perforation.
  • Laparoscopy's utility, accuracy, and cardiopulmonary impact were assessed.

Purpose of the Study:

  • To evaluate the safety and efficacy of laparoscopy in critically ill surgical intensive care unit (ICU) patients.
  • To determine the diagnostic accuracy of laparoscopy for specific abdominal conditions.
  • To assess the hemodynamic stability during laparoscopy in this patient population.

Main Methods:

  • Twenty-six surgical ICU patients with suspected abdominal sepsis underwent diagnostic laparoscopy.
  • Nineteen patients were post-cardiac surgery; others had varied diagnoses.
  • Hemodynamic monitoring and inotropic support were utilized; bedside laparoscopy was performed in eight cases.

Main Results:

  • Laparoscopy correctly diagnosed acute cholecystitis in 10 of 15 patients, leading to appropriate surgical or interventional management.
  • In suspected mesenteric ischemia, laparoscopy identified the condition in five patients, revealing cirrhosis or ischemic bowel.
  • One case of colonic perforation was identified; no adverse hemodynamic events occurred during the procedures.

Conclusions:

  • Laparoscopy is a safe procedure for critically ill patients, even those in the ICU.
  • It is particularly valuable for diagnosing acute cholecystitis and evaluating mesenteric ischemia in post-cardiac surgery patients with refractory lactic acidosis.

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