A Descriptive Study on Intra and Post Operative Complications of Laparoscopic Abdominal Surgery

Yuvaraj, K (2010) A Descriptive Study on Intra and Post Operative Complications of Laparoscopic Abdominal Surgery. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTON: Informatics, electronics and robotics are intermingled fields that constantly change the way we experience our life and practice medicine. Despite many decades of these technological developments the performance of surgical operations (the cutting and suturing of the artisan remained unchanged. The advent of minimally invasive surgery, brought about a major deviation from traditional surgery .this method has several advantages over the traditional system, but it require sophisticated instruments, training and skill. The application of laparoscopy in current surgical practice is undergoing constant changes and rapid developments. These developments have to be weighed against over-enthusiasm and the problems created by a lack of familiarity with new techniques and instruments. Without these things, we sometime land up in complications. This dissertation mainly focuses on minimally invasive surgery and its complications. AIM OF THE STUDY: 1. To understand the physiological changes occurring during laparoscopic procedures. 2. To analyze various laparoscopic surgeries done in our department. 3. To study various complications occurring during intra and post operative periods in laparoscopic surgery. 4. To evaluate the guidelines for preventing them. 5. To assess the outcomes of the complications. 6. To study the presentations and interventions. MATERIALS AND METHODS: The prospective study was done in Govt Royapettah Hospital and Kilpauk Medical College, over a period of 28 months from June 2007 to October 2009. During this study a total of 134 patients were categorized and assigned to various procedure groups. The patients were assigned to a surgical procedure based on the symptoms, clinical features, diagnostic criteria and investigations. Inclusion Criteria: All patients who presented with clinical features and imaging features suggestive of chronic abdominal pathology and were planned for elective open surgery. Exclusion Criteria: All patients with acute abdominal complaints due to the underlying pathology were excluded. Patients with uncontrolled hypertension, diabetes and known cardiac complications were not included. Patients apprehensive about the technique, and patients who were considered to be of the poor follow up group were excluded. Patients who were not fit for general anaesthesia due to any other cause were also excluded in the study. ANALYSIS: The potential complications of laparoscopic procedure include those related to laparoscopy and those related to specific procedure. The majority of these complications occur during the early learning phase for laparoscopy. They may also occur however, during procedures performed by surgeons who have considerable laparoscopic experience due to the disease process per se. As new application for laparoscopy continue to emerge, it is important for the surgeon to be familiar with the possible complication associated with the various laparoscopy procedure. Very good infrastructure, adequate and proper training and skill are mandatory to minimize the complication and good surgical outcome. Only through an appreciation of the potential complications of a procedure and their overall incidence be reduced to minimum. CONCLUSION: In this study the rate of complications observed were more within the various literary reviews published and accepted worldwide. The rate of conversion to laparotomy was 2.5% against a average ranging between 4-8%. Our series indicated an overwhelming patient satisfaction in particular reference to postoperative pain with a low incidence of <2%. Complications related to carbon dioxide pneumoperitoneum and increased intra-abdominal pressure did not really occur. In our series, the morbitity, were low and acceptable. The reported major complications raised the morbitity to 1.1%; they prolonged hospital stay, but without any further unwilling consequences. As in all aspects of medicine, laparoscopic surgery requires experience on the part of the surgeon in order to afford patients the best possible outcome. The anatomy visible through a laparoscope differs in perspective from that presented in the open case, basic techniques such as suturing have to be relearned, and there is a decrease in tactile sense as an instrument is interposed between fingertip and tissue. Several surgeons have defined a learning curve for laparoscopic procedures after which the rate of complications plateau and most series note a decrease in the time necessary to complete a procedure from the first cases to the last. Adequate instruction and super-vision would seem prudent as a surgeon ascends the learning curve. Ultimately, complications can be minimized but never avoided. Expeditious diagnosis and appropriate management of complications are requisite of all surgeons. The conclusion drawn from this study is that laparoscopic surgery is a safe procedure with low morbidity rate. Complications can be minimized by maintaining a low threshold for conversion. Conversion is never a failure, it is a mark of PRUDENCE.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Laparoscopic Abdominal Surgery ; Intra and Post Operative Complications ; Descriptive study.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 01 Jun 2018 13:55
Last Modified: 01 Jun 2018 13:55
URI: http://repository-tnmgrmu.ac.in/id/eprint/8123

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