Previous Open Abdominal Surgery And Laparoscopic Surgery

Previous abdominal surgery is generally considered a risk factor for bowel injury during subsequent laparoscopic access and dissection. The effect of previous abdominal surgery (open or laparoscopic) on urological laparoscopy in a single center was studied by Parsons et al. (36). Of the 700 patients 52% (366) had never undergone abdominal surgery, 15% (105) had history of abdominal surgery at the same anatomical region, and 33% (229) had abdominal surgery at a different region. The complication rates for patients who had no previous surgery, who had same-site surgery, and who had different site surgery were 4.8%, 9.4%, and 10.7%, respectively. Conversion to open surgery was 1.2%, 7.5%, and 5.7%, respectively. However, there was no statistical differences between the above three groups in terms of complication (p = 0.11) and conversion (p = 0.08) rates in patients with and without previous abdominal surgery.

Mechanical bowel preparation is recommended in patients with prior abdominal surgery due to the increased risk of bowel injury in these cases. Bowel preparation will not decrease the risk of bowel injury, but may avert a diverting colostomy if an injury should occur. Application of open direct vision (Hasson) trocar placement may help to minimize the risk of bowel injury in patients with prior abdominal surgery. Patients with prior abdominal laparoscopic surgery represent a special case. Pattaras et al. compared postoperative adhesion formation after open and laparoscopic procedures and demonstrated that de novo bowel adhesions following operative laparoscopy were minimal (37). While care is still required in patients with prior laparoscopic abdominal surgery, the risk of bowel injury is likely smaller compared to that in patients with prior open surgery.

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