PUSHING THE LIMITS OF LAPAROSCOPY IN COMPLEX ACUTE CARE SURGERY (ACS)
Winnie Feng*, Nathaniel Rubalcava, Paul R. Del Prado
Creighton University Arizona Health Education Alliance, Tempe, AZ
Laparoscopy in ACS can prove challenging, compared to the traditional laparotomy. However, in medically complex patients, it may decrease morbidity and shorten recovery. We present a systematic approach to these cases that includes: 1) 4-quadrant evaluation, 2) local irrigation, 3) endoscopic leak test, and 4) wide drainage. We demonstrate the efficacy of this algorithm in 2 case studies.
A 64 yo man with CAD, CKD, and BMI 40 had a 3-cm gastric perforation and underwent a partial gastrectomy without post-op complications. A 78 yo man with Child C cirrhosis, COPD, and pulmonary HTN had a perforated D1 ulcer repaired with an omental patch. His post-op bile leak was successfully managed non-op.
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