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Laparoscopic Redo Surgery

Laparoscopic Redo Surgery. Bradley R. Davis, MD, FACS, FASCRS Associate Professor of Surgery Director Surgical Education/Surgical Skills Lab Program Director Residency in General Surgery University of Cincinnati. Disclosures. Paid Consultant for Ethicon Endo Inc. Re-operative Surgery.

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Laparoscopic Redo Surgery

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  1. Laparoscopic Redo Surgery Bradley R. Davis, MD, FACS, FASCRS Associate Professor of Surgery Director Surgical Education/Surgical Skills Lab Program Director Residency in General Surgery University of Cincinnati

  2. Disclosures • Paid Consultant for Ethicon Endo Inc.

  3. Re-operative Surgery • Restorative proctectomy following TAC • Stoma reversal • Recurrent Crohn’s disease • Parastomal hernias • Postoperative Complications • Adhesiolysis

  4. Laparoscopic Redo Surgery • Success influenced by conduct of index procedure • Laparoscopic Index Procedure • Open Index Procedure • As a general rule re-operative surgery can be attempted laparoscopically

  5. Lap IPAA • Pouch surgery often performed in three phases • Emergent, urgent or elective total colectomy • Proctectomy with ileal pouch anal anastomosis • Closure of ileostomy

  6. Lap IPAA following Open EC

  7. Lap vs Open IPAA following EC

  8. Laparoscopic IPAA • If index procedure done laparoscopically consider Pfannenstiel for specimen retrieval and Pouch creation • All adhesions need to be divided to ensure adequate pouch length • If index procedure performed lap then proctectomy should prove feasible

  9. Lap Hartmann’s Closure • Tips • Take down the stoma first • Assess adhesions through stoma aperture • Place single 5mm trocar • Assess adhesion laparoscopically • Make a quick decision • Intra-loop adhesion and significant pelvic adhesions can prove too much

  10. Open vs. Lap Hartmann’s Reversal

  11. Lap Hartmann’s Closure

  12. Redo Laparoscopy for Recurrent CD • Fistulizing CD predictor of failure • Index surgery done open – no reports • Conversion rates consistently high

  13. Re-operative Laparoscopy for CD Colorectal Dis. 2011 Mar;13(3):302-7

  14. Recurrent Crohn’s Disease Lap

  15. Laparoscopic Hernia Repair • Laparoscopic incisional hernia repair well accepted practice with good long term data • In the absence of obstructive symptoms inter-loop adhesions can be left • If index procedure performed laparoscopically – hernia repair is routine

  16. Hernia Repair Hernia Recurrence Length of Stay

  17. Parastomal Hernia JSLS. 2009 Apr-Jun;13(2):170-5.

  18. Management of Postoperative Complications • Consider management laparoscopically for postoperative complications • Early postoperative small bowel obstruction • Internal hernias • Trocar hernis • Adhesive SBO • Creation of stoma in cases of anastomotic complications

  19. Movies • Parastomal hernia with cecum • Internal hernia following extended left colectomy • Recurrent CD

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