UPDATED TOPICS IN MINIMALLY INVASIVE ABDOMINAL SURGERY

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232 Updated Topics in Minimally Invasive Abdominal Surgery Although most studies are retrospective, this conservative approach has a clear advantage. However, there is a consensus on the fact that laparoscopic washing and drainage is not recommended for cases of fecal peritonitis, and the results are unsatisfactory for cases of formation of an abscess in the pelvis. Several prospective and randomized studies are being conducted in order to better define in which clinical situations this approach should be indicated (Toorenvliet et al., 2010). 9. Conclusion Access by laparoscopy seems to be of advantage over laparotomy as a diagnostic and therapeutic method in the approach to peritonitis and sepsis of abdominal origin by involving a lower surgical trauma, by providing a good field of view of the peritoneal cavity and by permitting to obtain tissue and fluid samples under direct vision. The rate of unnecessary laparotomies can be reduced when laparoscopy is used for a diagnostic and therapeutic approach in cases of acute abdomen, even in the presence of peritonitis or sepsis of abdominal origin. In the management of peritonitis by laparoscopy, the inflammatory response is milder compared to management by laparotomy. The elevation of inflammatory cytokines is moderate and macrophages present a better basal immunologic performance. In contrast to what occurs with laparotomy, the acute phase of the inflammatory response associated with perioperative sepsis is attenuated during laparoscopy, and the immune function seems to be better preserved after the latter. Despite the doubts about the feasibility and efficiency of laparoscopy compared to laparotomy for the approach to peritonitis, minimally invasive surgery is gaining acceptance among surgeons, especially regarding patients with abdominal sepsis. 10. Acknowledgments Financial support: Fundação Waldemar Barnsley Pessoa 11. References Almeida J, Sleeman D, Sosa JL, Puente I, McKenney M & MartinL. (1995). Acalculous cholecystitis: the use of diagnostic laparoscopy. J Laparoendosc Surg, Vol. 5, pp. (227– 231). Balague C, Targarona EM, Pujol M, Fillela X, Espert JJ & Trias M. (1999). Peritoneal response to a septic challenge comparison between open laparotomy, pneumoperitoneum laparoscopy, and wall lift laparoscopy. Surg Endosc, Vol.13, pp. (792–796). Bloechle C, Emmermann A, Strate T, Scheurlen UJ,Schneider C, Achilles E, Wolf M, Mack D, Zornig C & Broelsch CE (1998). Laparoscopic versus open repair of gastric perforation and abdominal lavage of associated peritonitis in pigs. Surg Endosc, Vol. 12, pp. (212–218). Boyd WP Jr & Nord HJ (2000). Diagnostic Laparoscopy. Endoscopy, Vol. 32, No.2, pp. (153-158) Brandt CP, Priebe PP & Eckhauser ML. (1993). Diagnostic laparoscopy in the intensive care patient. Avoiding the nontherapeutic laparotomy. Surg Endosc , Vol. 7, No.3, pp. (168- 172).
Laparoscopic Approach to Abdominal Sepsis Brandt CP, Priebe PP, & Jacobs DG. (1994). Value of laparoscopy in trauma ICU patients with suspected acute acalculous cholecystitis. Surg Endosc, Vol. 8, pp.(361–364). Branicki FJ. Abdominal Emergencies: Diagnostic and Therapeutic Laparoscopy (2002). Surgical Infections, Vol. 3, No.3, pp. (269-282). Buunen M, Gholghesaei M, ET, Veldkamp R, Meijer DW, Bonjer HJ & Bouvy ND. (2004). Stress response to laparoscopic surgery. Surg Endosc, Vol.18. pp. (1022-1028). Catena F, Di Saverio S, Kelly MD, Biffi WL, Ansaloni L, Mandalá V, Velmahos GC, Sartelli M, Tugnoli G, Lupo M, Mandalá S, Pinna AD, Sugarbaker PH, Van Goor H, Moore EE & Jeekel J. (2011). Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence Based Guidelines of the World Society of Emergency Surgery. World Journal of Emergency Surgery, Vol. 21, pp. (6.5). Chatzimavroudis G, Pavlidis TE, Koutelidakis I, Giamarrelos-Borboulis EJ, Atmatzidis S, Kountopoulo U, Marikis G & Atmatzidis Kl. (2009).CO2 Pneumoperitonium Prolongs survival in an animal model of peritonitis compared to laparotomy. Journal of Surgical Research, Vol. 152, pp. (69–75). Colonval P, Navez B, Cambier E, Richir C, de Pierpont B, Scohy JJ & Guiot P. (1997). Is laparoscopic cholecystectomy effective and reliable in acute cholecystitis? Results of a prospective study of 221 pathologically documented cases. Arch Chir, Vol. 51, No. 7, pp. (689-696). Cuesta MA, Eijsbouts QA, Gordijn RV, Borgstein PJ & De Jong D. (1998). Diagnostic laparoscopy in patients with an acute abdomen of uncertain etiology. Surg Endosc, Vol. 12, pp. (915–917). Cueto J, Díaz O, Garteiz D, Rodríguez M & Weber A. (1997). The efficacy of laparoscopic surgery in the diagnosis and treatment of peritoniotis. Surg Endosc, Vol. 11, pp. ( 366- 370). Decadt B, Sussman L, Lewis MP, Secker A, Cohen L, Rogers C, Patel A & Rhodes M. (1999). Randomized clinical trial of early laparoscopy in the management of acute nonspecific abdominal pain. Br J Surg, Vol. 86, pp. (1383–1386). Easter DW, Cuschieri A, Nathanson LK & Lavelle-Jones M. (1992). The utility of diagnostic laparoscopy for abdominal disorders. Audit of 120 patients. Arch Surg, Vol. 127, No. 4, pp. (379-383) Fahel E, Amaral PC, Filho EM, Ettinger JE, Souza EL, Fortes MF, Alcaˆtara RS, Regis AB, Neto MP, Sousa MM, Fogagnoli WG, Cunha AG, Castro MM & Santana PA Jr. (1999). Nontraumatic acute abdomen: videolaparoscopic approach. JSLS, Vol. 3, pp. (187– 192). Forde KA & Treat MR. (1992). The role of peritoneoscopy (laparoscopy) in the evaluation of the acute abdomen in critically ill patients. Surg Endosc, Vol. 6, No.5, pp. (219-221). Gadallah MF, Torres-Rivera C, Ramdeen G, Myrick S, Habashi S & Andrews G. (2001). Relationship between intraperitoneal bleeding, adhesions, and peritoneal dialysis catheter failure: a method of prevention. Adv Perit Dial, Vol. 17, pp.(127-129). Gagne´ DJ, Malay MB, Hogle NJ & Fowler DL. (2002). Bedside diagnostic minilaparoscopy in the intensive care patient. Surgery, Vol. 131, pp.(491–496). Gaitań H, Angel E, Sańchez J, Go´mez I, Sańchez L & Agudelo C. (2002).Laparoscopic diagnosis of acute lower abdominal pain in women of reproductive age. Int J Gynaecol Obstet, Vol. 76, pp. (149–158). 233
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VI Contents Chapter 9 Appendicitis
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Part 1 Laparoscopic Biliary-Pancrea
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4 Updated Topics in Minimally Invas
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Laparoscopic Liver Resection 2.2.1
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Laparoscopic Liver Resection of 64
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Laparoscopic Liver Resection (Bruix
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Laparoscopic Liver Surgery non rand
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