Early Laparoscopy Research Articles

Large ileal fecalith presenting as subacute obstruction and mimicking appendicitis: a case report

In patients with right lower quadrant pain post-appendectomy, consideration of alternative diagnoses is crucial. This case illustrates the rare presentation of a large ileal fecalith masquerading as constipation and McBurney's tenderness, emphasising the role of radiographic assessment in decision-making. Early diagnostic laparoscopy was instituted for a thorough survey of the abdomen for causes of fecalith. A single fecalith was identified 15 cm from the ileocolic junction while the rest of the bowel was normal. The 4×3.6 cm stone was retrieved by longitudinal enterotomy 10 cm proximal to the site of impaction followed transverse closure to prevent stricture formation. The extraction performed via minilaparotomy under laparoscopic guidance proved pivotal, leveraging the advantages of minimally invasive surgery and facilitating a swift recovery process.

Meta-analysis of the effectiveness of early endoscopic treatment of Acute biliary pancreatitis based on lightweight deep learning model

BackgroundAcute biliary pancreatitis (ABP) is a clinical common acute abdomen. After the first pancreatitis, relapse rate is high, which seriously affects human life and health and causes great economic burdens to family and society. According to a great many research findings, endoscopic retrograde cholangiopancreatography (ERCP) is an effective treatment method. However, whether ERCP should be performed in early stage of ABP is still controversial in clinical practice.MethodsRelated articles were retrieved from Pubmed, Web of Science core library, Nature, Science Direct, and other databases published from January 2000 until now. The keywords included early ERCP, delayed ERCP, ABP, laparoscopy, and cholecystectomy, all which were connected by “or” and “and”. The language of articles was not restricted during the retrieval and Review Manager5.3 was employed to perform meta-analysis of experimental data. Finally, a total of 8 eligible articles were selected, including 8,801 patients.ResultsThe results of the meta-analysis demonstrated that no remarkable differences were detected in the incidence of complications, mortality, and operation time between patients undergoing ERCP in early stage and those receiving delayed ERCP. However, the hospitalization time of patients in experimental group was notably shorter than that among patients in control group.ConclusinsEarly ERCP treatment is as safe as late ERCP treatment for biliary pancreatitis, and can significantly shorten the hospital stay. Hence, the therapy was worthy of clinical promotion. The research findings provided reference and basis for clinical treatment of relevant diseases.

Evaluation of place of early diagnostic laparoscopy and hysteroscopy in female infertility - right approach at right time for improved outcome

Evaluation of place of early diagnostic laparoscopy and hysteroscopy in female infertility - right approach at right time for improved outcome

Performance of three predictive scores to avoid delayed diagnosis of significant blunt bowel and mesenteric injury: A 12-year retrospective cohort study.

Avoiding missed diagnosis and therapeutic delay for significant blunt bowel and mesenteric injuries (sBBMIs) after trauma is still challenging despite the widespread use of computed tomography (CT). Several scoring tools aiming at reducing this risk have been published. The purpose of the present work was to assess the incidence of delayed (>24 hours) diagnosis for sBBMI patients and to compare the predictive performance of three previously published scores using clinical, radiological, and laboratory findings: the Bowel Injury Prediction Score (BIPS) and the scores developed by Raharimanantsoa Score (RS) and by Faget Score (FS). A population-based retrospective observational cohort study was conducted; it included adult trauma patients after road traffic crashes admitted to Lausanne University Hospital, Switzerland, between 2008 and 2019 (n = 1,258) with reliable information about sBBMI status (n = 1,164) and for whom all items for score calculation were available (n = 917). The three scores were retrospectively applied on all patients to assess their predictive performance. The incidence of sBBMI after road traffic crash was 3.3% (38 of 1,164), and in 18% (7 of 38), there was a diagnostic and treatment delay of more than 24 hours. The diagnostic performances of the FS, the RS, and the BIPS to predict sBBMI, expressed as the area under the receiver operating characteristic curve, were 95.3% (95% confidence interval [CI], 92.7-97.9%), 89.2% (95% CI, 83.2-95.3%), and 87.6% (95% CI, 81.8-93.3%) respectively. The present study confirms that diagnostic delays for sBBMI still occur despite the widespread use of abdominal CT. When CT findings during the initial assessment are negative or equivocal for sBBMI, using a score may be helpful to select patients for early diagnostic laparoscopy. The FS had the best individual diagnostic performance. However, the BIPS or the RS, relying on clinical and laboratory variables, may be helpful to select patients for early diagnostic laparoscopy when there are unspecific CT signs of bowel or mesenteric injury. Prognostic and Epidemiological; Level III.

Outcome of diagnostic laparoscopy in young patients presenting with acute nonspecific abdominal pain.

Objective: To assess the role of diagnostic laparoscopy in young patients with Non-specific abdominal pain. Study Design: Prospective study. Setting: General Surgery Department, Hayatabad Medical Complex Peshawar. Period: January 2021 to December 2021. Material & Methods: A total of 140 young patients between the ages of 15 and 30 who had diagnostic laparoscopy for non-specific abdominal pain and met the inclusion criteria were included. Dates of admission, dates of operation, demographic and clinical information about patients were recorded. Results: 140 patients in all were enrolled. The mean age was 22.5 years, with a range of 15 to 30 years. There were 50(35.7%) females and 90(64.3%) males, of the total. Diagnoses and therapeutic treatment were feasible in 95 cases (67.8%), no pathology was found in 29 cases (20.7%), the preoperative picture was uncertain in 11 cases (7.8%), and no diagnosis was obtained following laparoscopy in 5 cases (3.6%), respectively. Conclusion: Early diagnostic laparoscopy in young patients is a safe and effective procedure. As a result, it is a useful investigative technique for acute abdominal pain that has not been properly identified.

113 Exploratory laparoscopy in suspected bowel obstruction secondary to a transmesenteric hernia

Abstract Background Transmesenteric hernias (TH) in adults are an uncommon subtype of internal hernia that can be life-threatening because of the risk of bowel ischemia if not correctly diagnosed. Case report A 79-year-old man came to the emergency department with abdominal pain associated with vomiting and constipation for 24 hours. Physical examination showed no alarm signs. However, due to the presence of leukocytosis with neutrophilia and an abdominal X-ray with suspected obstruction, an abdominal CT scan was requested. Given the radiological finding of a defect in the mesentery through which a portion of the mesentery and several loops of bowel were introduced, an exploratory laparoscopy was indicated on suspicion of TH. Intraoperatively, 150 cm from the ileocecal valve, a 30 cm congestive segment of jejunum was observed, which was inserted in a 4 cm long eyelet in the omentum. Reduction of the herniated small bowel loops through the eyelet was performed without difficulty, observing good viability of the loops, and the eyelet was opened with scissors leaving the omentum open at the distal end. The patient was discharged on the 5th postoperative day tolerating oral diet, with transit and the surgical wound without signs of infection. Conclusion Although CT is the best diagnostic test for TH its preoperative diagnosis remains difficult. In the case of suspected TH, early exploratory laparoscopy is a correct technique that can preserve the viability of the bowel.

Early laparoscopic-assisted surgery is associated with decreased post-operative inflammation and intestinal strictures in infants with necrotizing enterocolitis

IntroductionIn 2015, a protocol including early laparoscopy-assisted surgery in the treatment of necrotizing enterocolitis (NEC) was implemented at our institution. Carbon dioxide insufflation during laparoscopy may have an anti-inflammatory effect. We aimed to compare post-operative outcome after early laparoscopy-assisted surgery and classical laparotomy for NEC. Material and methodsCharts of premature infants undergoing surgery for NEC (2012–2021) were reviewed. Cases operated by early laparoscopy-assisted surgery (2015–2021) were compared to infants operated for NEC between 2012 and 2015 (laparotomy-NEC). Outcomes were post-operative CRP, need for reintervention, mortality, and the occurrence of post-NEC intestinal strictures. CRP was measured on the day of surgery (POD-0), 2 days (POD-2), and 7 days after surgery (POD-7). Data were compared using contingency tables for categorical variables and Student t-test or Mann–Whitney test for continuous variables. ResultsInfants with NEC operated by early laparoscopy (n = 48) and laparotomy (n = 29) were similar in terms of perforation (60% vs 58%, p = 0.99) and POD-0 CRP (139 vs 124 mg/L, p = 0.94). Delay between first signs of NEC and surgery was shorter in the laparoscopy group (3 vs 6 days, p = 0.004). Early laparoscopy was associated with a lower CRP on POD-2 (108 vs 170, p = 0.005) and POD-7 (37 vs 68, p = 0.002), as well as a lower rate of post-operative intestinal stricture (34% vs 61%, p = 0.04). ConclusionsIn addition to being safe and feasible in premature infants, early laparoscopic-assisted surgery was associated with decreased NEC-related post-operative inflammation and strictures. A prospective, randomized study is needed in order to evaluate short and long-term effects of laparoscopy in infants with NEC. Level of evidenceLevel III.

Does Diagnostic Laparoscopy Still Have a Role in the Evaluation of Right Iliac Fossa Pain Versus Imaging Techniques or Experience?

Background Right iliac fossa (RIF) pain is the most common cause of emergency surgical presentation, and a significant number of patients are eventually diagnosed with acute appendicitis. Typically, appendicitis is a clinical diagnosis, and it is prudent to take the patient to theatre for an early diagnostic laparoscopy (DL) to prevent complications as a result of acute appendicitis with the caveat it may lead to an increased number of negative appendectomies. The primary objective of this study was to ascertain the efficacy of DL in tackling RIF pain. The secondary objective was to compare the results among the diagnostic versus imaging groups (negative appendectomy rate, postoperative complications, and length of stay). Methodology The data were collected retrospectively for patients presenting with RIF pain in the surgical unit of the Royal Oldham Hospital between April 2017 and March 2019. The electronic database was utilized to identify all patients who underwent appendicectomy during this period. Patients were divided into two groups, group one had DL as their primary operation, and group two had imaging prior to surgery. Group two was further subdivided into computed tomography (CT) and ultrasonography (USG). Data included blood results, imaging reports, intraoperative findings, length of stay (LOS), postoperative complications, and histopathology results. The data were analysed using an Excel sheet and SPSS version 27 (IBM Corp., Armonk, NY, USA). Results A total of 340 patients were identified. Group one had 165 (48.53%) and group two had 175 (51.47%) patients. Most surgeries were carried out by middle-grade doctors (80.95%). Comparison with the histopathology report revealed that the negative appendectomy rate was 20% in group one, 3.8% in the CT group, and 27.5% in the USG group. The average length of stay was 2 ± 1.38 days in the diagnostic group and 3 ± 2.7 and 3 ± 0.8 days in subsequent groups. Conclusions This study shows that DL is a valuable first option when trained surgeons are available for tackling RIF pain, particularly in the young age group where it can reduce the risk of radiation exposure, decrease LOS, and avoid complications because of perforation.

EP-49 First reported case of preperitoneal herniation of small bowel causing intestinal obstruction after total extraperitoneal hernia [TEP] repair- case report and review of the literature

Abstract Introduction A pre-peritoneal hernia is a very rare complication following laparoscopic inguinal hernia repair. We report a patient who developed a preperitoneal hernia following an accidental breach of peritoneum following Total extraperitoneal repair [TEP]. Even though it has been described following total abdominal pre peritoneal repair [TAPP], to the best of our knowledge this is the first reported case following TEP repair. Case presentation A 57-year-old male underwent right inguinal hernia TEP repair on 20/10/2021. Initial recovery was uncomplicated but on POD 10 he developed sudden onset of vomiting and abdominal pain. Initial imaging showed small bowel obstruction without a definite transition point. We maintained a high index of suspicion for internal hernia and he was offered urgent diagnostic laparoscopy after careful counseling. A preperitoneal defect was noted with distended proximal ileum and collapsed distal ileum and colon. Small bowel run through which did not reveal any pathological abnormalities. A presumptive diagnosis of preperitoneal hernia was made, and the defect was closed with a running V lock suture. The patient made an uneventful recovery post-operatively. Conclusion An inadvertent breach in peritoneum during TEP repair can lead to preperitoneal of small bowel and intestinal obstruction postoperatively. This is the first-ever reported case of this very rare complication following TEP that hernia and general surgeons should be aware of. A high degree of suspicion is needed and early diagnostic laparoscopy is indicated if suspected to avoid morbidity and mortality from bowel ischemia.

Laparoscopic management of ischemic right fallopian tube torsion mimicking perforated appendicitis.

BackgroundIsolated fallopian tube torsion is a rare cause of acute lower abdominal pain in females. A history of hemosalpinx, hydrosalpinx, or ovarian or paraovarian cysts might all be risk factors. Diagnosis is frequently delayed until it's too late to salvage the tube.Case presentationA 32-year-old lady with no prior medical and surgical history presented to our emergency department with a four days history of severe right lower abdomen pain and tenderness accompanied by nausea. Clinically, she was feverish, with elevated C reactive protein levels, negative serum Beta HCG, and normal urine analysis. Computed tomography demonstrated a 5x3cm collection in the right lower quadrant of the abdomen. A diagnostic laparoscopy was performed upon exploration a Twice-fold twisted ischemic right fallopian tube with hydrosalpinx was found and Salpingectomy was performed.ConclusionsTorsion of the fallopian tube is an uncommon cause of acute lower abdominal pain in women. The exact process that causes isolated tubal torsion is unknown. Early diagnostic laparoscopy and surgical intervention are essential in a nulliparous young woman.

Retrieval of a missed intraperitoneal gallstone with early second look laparoscopy

Retrieval of a missed intraperitoneal gallstone with early second look laparoscopy

Early Re- Laparoscopy in Suspected Bile Duct Injuries after Laparoscopic Cholecystectomy

Introduction: Management of patients with suspected bile leak or bile duct injury after laparoscopic cholecystectomy is challenging. Early laparoscopy in these groups of patients will benefit in terms of diagnostic as well therapeutic purpose.
 Objective: This study is done to assess utility of early re-laparoscopy in suspected bile duct injury in early postoperative period following laparoscopic cholecystectomy.
 Methodology: It is a descriptive study of all consecutive patients who underwent diagnostic as well therapeutic re-laparoscopy when required in suspected bile duct injury in early postoperative laparoscopic cholecystectomy that is within 72 hours of presentation. Study was conducted over a period from June 2019 to December 2020 at Kathmandu medical College, Sinamangal, Kathmandu, Nepal. Relaparoscopic operative findings and therapeutic intervention done were recorded.
 Result: The mean age at presentation was 34.6 years and male to female ratio was 1:1.8. During the study period, eleven patients underwent re-laparoscopy out of which one had no bile leak. Six out of ten were managed definitely in the same time of re-laparoscopy. However, four patients underwent definitive biliary reconstruction as they had already undergone arteriography in CT scan.
 Conclusions: Early re-laparoscopy may be beneficial prior to detail radiological investigations in suspected bile leak patients. Early re-laparoscopy can be an effective diagnostic as well therapeutic tool; and also it can help in planning for definitive repair in later date.

Role of laparoscopy in diagnosis of acute nonspecific abdominal pain

Background Acute nonspecific abdominal pain (NSAP) is frequently encountered in the daily medical practice. This prospective study was performed to elucidate the role of early laparoscopy in the management of NSAP and to compare it with active clinical observation in such cases. Patients and methods A total of 100 cases with acute NSAP were randomly divided into two groups: early diagnostic laparoscopy (EDL) group included 50 cases who underwent EDL, and observational group included the remaining 50 cases who were closely observed. Outcome measures included the definitive diagnosis, operative time, duration of hospitalization, and postoperative morbidity. Results No statistically significant difference was noticed between the study groups regarding demographics. However, the duration of symptoms showed significant prolongation in the observation group. Regarding the final definitive diagnosis, no significant difference was noticed between the two groups (P Conclusion Diagnostic laparoscopy appears to be a reliable tool to reach a definite diagnosis in patients with NSAP because of its superior diagnostic ability, better visualization, low complications, and the ability to manage the pathology in the same setting.

The Brief Case: Mycoplasma hominis Extragenital Abscess.

A 55-year-old woman with an unexplored 1-month history of rectal bleeding presented to the emergency department with abdominal pain, chills, and fever. The patient had received rituximab, a monoclonal antibody targeting the CD20 antigen expressed on B cells, for rheumatoid arthritis. An abdominal computed tomography (CT) scan highlighted a right perirectal collection and focal sigmoiditis with few diverticula (Fig. 1). Owing to sepsis, the patient received piperacillin-tazobactam in association with gentamicin and underwent an early laparoscopy to drain the collection a few hours after the initiation of antimicrobial therapy. Gram staining of the perirectal collection revealed numerous polymorphonuclear leukocytes with no visible microorganisms. Surgical samples and blood cultures remained sterile even after 5 days of incubation. The patient presented no improvement in her clinical condition. Persistent fever and recurring chills along with high levels of inflammatory blood markers resulted in a treatment change to vancomycin, cefepime, and metronidazole. A CT scan on day 10 showed a stable rectal abscess. On day 14, the antibiotics were replaced by meropenem, amikacin, and fluconazole due to the persistent fever. Other sets of blood cultures remained negative. The fever persisted with no explanation other than the rectal abscess.

Early laparoscopy versus observation for patients with acute abdominal pain

Early laparoscopy versus observation for patients with acute abdominal pain

A rare case of laparoscopy towards SLE with lupus mesenteric vasculitis induced ascites

BackgroundDiagnosis and management of acute abdomen secondary to systematic lupus erythematosus (SLE) has always been a clinical challenge.Case presentationA 21-year-old lady, with BMI 17.7, presented to our department with acute abdomen. Laparoscopy was carried out to exclude surgical emergency when conservative regimen failed. The patient revealed a history of purpuric changes and lupus test was positive for SLE.ConclusionBased on our experience, early laparoscopy to alleviate acute abdomen has shown to improve the prognosis of the patient.

Clinical characteristics of malignant peritoneal mesothelioma misdiagnosed as tuberculous peritonitis: a report of 6 cases

Objective: To reduce the misdiagnosis rate of ascites and improve the diagnosis rate of malignant peritoneal mesothelioma. Methods: From May 2008 to May 2018, in Xiangya Hospital of Central South University,the clinical data of malignant peritoneal mesothelioma misdiagnosed as tuberculous peritonitis were retrospectively analyzed. Results: (1) Among the 6 patients, they were male; the age of onset was 42-70 (52±9.57) years old, and there was no history of asbestos exposure. (2) All cases with abdominal pain or abdominal distension were there and the course of disease was more than 1 month to more than 2 years. (3) In all patients,the nature of ascites was exudate; ADA was higher than normal value and below 45 U/L; LDH value in ascites was higher than 200 U/L (83.3%); mesothelioma was considered in ascites cytology in 1 case. (4) Laparoscopic biopsy was performed in 2 cases and B-ultrasound guided biopsy in 4 cases; Among them, malignant peritoneal mesothelioma diagnosed by pathology. (5) In Immunohistochemical positive markers, MC was the most sensitive (100%), followed by CR (67%), CK-Pan (67%), Ki-67 (67%) and EMA (67%). (6) Two patients received treatment with operation, abdominal hyperthermic perfusion and postoperative systemic chemotherapy. Conclusions: (1) Malignant peritoneal mesothelioma should be considered in middle-aged and aged male patients with unexplained ascites and early laparoscopy or laparotomy for diagnosis. (2) ADA and LDH level in ascites are significant in differentiating tuberculous peritonitis from malignant peritoneal mesothelioma. (3) Immunohistochemical positive marker MC may be a potential specific marker for malignant mesothelioma. (4) The survival time of patients is improved by comprehensive treatment such as operation and chemotherapy.

A prospective observational study of the utility of early diagnostic laparoscopy for right lower abdominal pain: a safe and effective diagnostic and therapeutic tool.

Diagnostic laparoscopy is commonly performed for diagnosis of right lower abdominal pain and its use is increasing in the emergency setting. Some studies have reported that diagnostic laparoscopy and laparoscopic appendicectomy have advantages over conventional surgery. Many emergency surgeons now perform diagnostic laparoscopy for both clinically diagnosed appendicitis and when the diagnosis is in doubt. The aim of the present study was to assess whether the use of diagnostic laparoscopy is justified and safe for those admitted with right lower abdominal pain. Data were collected prospectively on consecutive patients attending the acute surgical receiving unit with right iliac fossa pain or a suspected diagnosis of acute appendicitis. A total of 284 patients underwent diagnostic laparoscopy. Of them 233 (82%) had a positive finding at laparoscopy, 207 (88%) underwent appendicectomy, the majority of which were carried out laparoscopically. Surgical trainees performed the majority of operations and this did not have a negative impact on operative findings (p 0.856), operation performed (0.642), or operative duration (0.831). No intra-operative complications were sustained. Ultrasound examination was carried out in 49 patients, while CT was carried out in 24. The results of the present study highlight the utility of early diagnostic laparoscopy as both a diagnostic and therapeutic tool in the acute setting.

Effectiveness and Adverse Events of Early Laparoscopic Therapy versus Conservative Treatment for Tubo-Ovarian or Pelvic Abscess: A Single-Center Retrospective Cohort Study

Background/Aim: We aimed to assess the value of early laparoscopic therapy in management of tubo-ovarian abscess (TOA) or pelvic abscess. Methods: This was a retrospective study of all consecutive patients who were initially diagnosed with TOA or pelvic abscess at the local hospital between January 2010 and December 2014. The risks of operation and recurrence were analyzed using logistic analyses. Results: The durations of body temperature > 38.0°C (p = 0.001) and hospitalization (p < 0.001) were longer in the conventional group versus the early laparoscopy group. In the conventional group, 15 (50%) patients finally underwent laparoscopic exploration. The abscess size in the late laparoscopic group was significantly larger than the successful antibiotic treatment group (6.3 ± 1.5 vs. 4.9 ± 1.2 cm, p = 0.010). Abscess > 5.5 cm was independently associated with antibiotic failure (OR 4.571; 95% CI 1.612–12.962). Compared with late laparoscopy, early laparoscopy was associated with a shorter operation time (p = 0.037), less blood loss (p = 0.035), and shorter durations of body temperature > 38.0°C (p < 0.001) and hospitalization (p < 0.001). The cost was the lowest in the patients successfully treated conservatively. Conclusion: Early laparoscopic treatment is associated with shorter time of fever resolution, shorter hospitalization, and less blood loss compared with conventional treatment for TOA or pelvic abscess.

Early laparoscopy in intestinal injury after blunt abdominal trauma

Early laparoscopy in intestinal injury after blunt abdominal trauma