Tags

Article Image

Everything about Exploratory laparoscopy

  • Posted on- Jan 05, 2018
  • 80 Views
  • 0
Written by site author.

Exploratory laparoscopy is also known as diagnostic laparoscopy. Exploratory Laparoscopy is a small method for the medication of intra-abdominal disease with the help of intra-abdominal organs. Exploratory laparoscopy also allows tissue biopsy, culture acquisition, and a variety of therapeutic interventions.

Laparoscopic ultrasonography (LUS) is also being performed during exploratory laparoscopy to evaluate organs that are not amenable to inspection. Diagnostic laparoscopy is useful for making a definitive clinical diagnosis whenever there is a diagnostic dilemma even after routine diagnostic workup, including patients with nonspecific abdominal pain, hemodynamically stable sustained blunt/penetrating trauma with suspected intra-abdominal injuries, and critically ill intensive care unit (ICU) patients with suspected intra-abdominal sepsis or pathologies.



What are the biopsies included in Exploratory Laparotomy?



Following are the biopsies involved in exploratory laparotomy:


 1. Liver biopsy



One of the simplest methods to biopsy the liver is the ligature fracture technique. This method is limited in that only the edge of a liver lobe may be sampled, and a surgical assistant is usually needed. A loop of suture material (2-0) is used to strangulate liver tissue proximal to the proposed biopsy site. The tissue is then sharply divided distal to the ligature.

An equipment of fragmentation technique is the difference of fracture technique for acquiring small biopsies technique. The proposed biopsy site is isolated from the rest of the lobe by carefully crushing the hepatic parenchyma using either an instrument (e.g., Carmalt forceps) or the thumb and index finger.

 2. Intestinal biopsy



Rules for the gathering of biopsies of intestine inculcates the strength of intestine for getting of full-thickness samples, and protect the properly closed biopsy site. Technical considerations include the size of the biopsy specimen, closure technique, and protection of the incision.

Intestinal biopsies are efficiently obtained using a skin biopsy punch.  A 6 mm biopsy equipment which is mainly used in dogs, whereas 4 mm biopsy is mainly used in a cat. Position the biopsy punch at the antimesenteric aspect and exert rotary forces, taking care to avoid trauma to the opposite (mesenteric) aspect.

 3. Lymph node biopsy



Abdominal lymph nodes which are frequently sampled include the pyloric (pancreatic duodenal), colic, and medial iliac (sub lumbar) lymph nodes. Excisional or incisional biopsies are preferred to simple aspiration since morphologic interpretation is possible.

A simple blood supply which is adjacent to a tissue should be protected during incision lymph node biopsies, especially when sampling mesenteric lymph node(s). For excisional biopsies, divide the blood supply to the lymph node between sutures, and carefully dissect the lymph node from surrounding tissues.



What is the procedure of exploratory laparotomy?



A midline incision is carried down to the linea Alba and the fascia is incised. The peritoneum is entered and any immediate, life-threatening bleeding is identified and controlled. Superior and anterior surface of the liver is packed with sponges and the other spaces are also similarly packed. The bowel is run from the ligament of Treitz to the terminal ileum.

The gastrocolic ligament is incised and the lesser sac is explored, including the posterior stomach and the anterior pancreas. The surface of the spleen is examined for evidence of laceration and fracture. The liver is similarly examined. If necessary, Cattell and Mattox maneuvers may be performed to expose retroperitoneal structures. When the duodenum is at risk, a Kocher maneuver is performed for examination of the posterior duodenum and the head of the pancreas.


What are the contraindications of exploratory laparotomy?



Patient selection for diagnostic laparoscopy with the identification of relative or absolute contraindications is vital to a successful outcome of the laparoscopic procedure. In addition to a detailed history and meticulous physical examination, special effort should be made to identify the prior history of abdominal surgery, intra-abdominal abscess, perforated appendicitis, or the presence of intra-peritoneal mesh for a ventral hernia, these conditions may be associated with substantial adhesions. Laboratory studies, electrocardiography (ECG), and chest radiography should be performed according to the same criteria relevant to any surgical procedure necessitating general anesthesia.


What are the indications of exploratory laparotomy?



Acute abdominal pain is one of the most common indications for an emergency department (ED) visit. Out of 30-40% patients, the pain in abdomen remains same along with laboratory and radiological investigations. When a diagnosis of the persistent acute abdominal pain of fewer than 7 days' duration remains uncertain after baseline diagnostic and radiologic investigations, this condition is termed nonspecific abdominal pain (NSAP).

Traditionally, these patients have been treated with either an open exploratory laparotomy for conditions the patient was presumed to have or active observation.

Unfortunately, these approaches were often associated with prolonged hospital stays, increased numbers of radiologic imaging studies and laparotomies with negative findings, and patient dissatisfaction if the diagnosis could not be established. This scenario is especially prevalent in pregnant women and obese patients, in whom availability or access to imaging studies is limited by the gestational age or the patient’s size.

The Minimum cost of exploratory is Rs. 3,50,000 to maximum Rs. 7,00,000.

Comments

Ask a Query