Patients In Laparotomy Group Research Articles

Hernioscopy is a good option in strangulated inguinal hernias that retract under general anesthesia

We read with great interest the article entitled ‘‘Prognostic factors of postoperative morbidity and mortality in strangulated groin hernia’’ by Romain et al. [1]. The study aimed to find significant prognostic factors of postoperative morbidity and mortality, and the authors concluded that first intention exploratory midline laparotomy was a significant prognostic factor of postoperative mortality. In the minority of the patients with strangulated hernia, the contents of hernia sac can reduce spontaneously following the administration of muscle relaxants during induction of anesthesia, and an additional exploration will be necessary to inspect intra-abdominal contents. In their series, the authors had to perform an additional exploration in 12 patients, either with a midline laparotomy (3 patients with groin hernia, and 5 patients with femoral hernia) or with laparoscopy (1 groin hernia) or hernioscopy (3 groin hernia). While there were postoperative morbidity and mortality in 6 of 8 patients in laparotomy group, postoperative recovery after laparoscopy and hernioscopy was uneventful. Although choice of laparotomy might depends on a great suspicion of intestinal necrosis and effects the results, we think that hernioscopy rather than a laparoscopy is a good technique to start the evaluation of intraabdominal contents. Hernioscopy is an alternative technique for laparoscopy, where the trocar was placed through the dissected hernia sac [2]. Hernioscopy allows a full exploration of peritoneal cavity without the need for laparotomy. In the presence of a suspicious view of an intestinal segment or necrosis, hernioscopy can also be used for retrieval of effected bowel by insertion of a second trocar [3]. In case of an inadequate evaluation, the technique can be switched to a laparoscopy. Thus, the possible complications of laparotomy, such as postoperative ileus, evisceration, increased length of hospitalization, and increased cost, can be prevented. Our clinical experience and the literature information support that hernioscopy is a safe and simple technique and very useful in the evaluation of retracted intestinal segments. To avoid from an unnecessary laparotomy, hernioscopy can be used as an initial diagnostic technique.

Laparoscopic surgical management of ectopic pregnancy: a district general hospital experience

This is an audit of laparoscopic management of ectopic pregnancy in a District General Hospital (DGH), using a retrospective casenote review. The study was conducted at New Cross Hospital, Wolverhampton, a large DGH. We recorded the duration of operation, postoperative opiate requirement, length of hospital stay, operative and postoperative complications. Case notes of patients with surgically treated ectopic pregnancies between January 1996 and June 1998 ( n =106) were reviewed and grouped into three categories: (1) immediate laparotomy, (2) laparoscopy followed by laparotomy, and (3) laparoscopic management. Comparisons were made between the three groups. The incidence of ectopic pregnancy was 1-91 live births. The mean age of the patients was 29.9 years (range 14-41). Seven (6.6%) patients were haemodynamically unstable and underwent immediate laparotomy, 66 (62%) patients had laparoscopic management while 33 (31%) patients had laparotomy following preliminary laparoscopy. Mean operative time in the laparoscopic management group was 61.9 minutes. The mean - 2 SD was 61.9 - 37.4 (range 27-107) with a mean length of hospital stay of 1.9 days (range 1-4), compared with 49.9 minutes ( - SD 16.5 (range 35-98) and 3.9 days (range 2-8), respectively, in the laparotomy following preliminary laparoscopy group. Only one patient in the laparoscopic management group required opiate analgesia 24 hours postoperatively compared with all the patients in the immediate laparotomy group and seven patients (21%) in laparotomy following the preliminary laparoscopy group. Complications in the laparoscopic management group included wound infection and a persistent ectopic. One patient in the laparotomy group required subtotal hysterectomy for persistent bleeding from cornual ectopic, while complications in the laparotomy following the laparoscopy group consisted of minor wound infection and a case of deep venous thrombosis (DVT). Laparoscopic management of ectopic pregnancy is safe and can be carried out successfully in a DGH setting with clear advantages, including shorter hospital stay and reduced postoperative opiate requirement.