DIAGNOSTIC LAPAROSCOPY 1. What does diagnostic laparoscopy consist of? It is a surgical technique that is used for exploring the abdominal cavity of the patient leaving a very small scar. A 1 cm incision is done in the abdominal wall and the surgeon introduces an optic device (laparoscope) that is connected to a camera and obtains a magnified image of the inner organs of the patient. 2. When is diagnostic laparoscopy indicated? - When the patient presents a chronic abdominal pain and the reason for it has not been found with other tests. - In case of acute abdomen that may require urgent surgical intervention. - In the presence of a mass or abdominal tumor that has been detected in the physical exploration or in radiological tests. In such cases, it may be necessary to proceed with diagnostic laparoscopy before deciding the suitable treatment in order to evaluate the extension of the injury and take some samples (biopsies) of the tissue for their analysis in the microscope. Thus, we will be able to establish the exact cause for the disorder. - Liver illnesses and tumors: thanks to this technique an ultrasonography with a laparoscopic probe is possible. This permits a clearer definition of the injuries of the liver. Obtaining biopsies of the area that needs to be studied is also possible. - If the patient has been treated for cancer before and is not necessary to evaluate the current situation, diagnostic laparoscopy may be necessary in order to check the abdominal organs. The information that is obtained with this test is very important so as to decide the most suitable treatment. 3. How to prepare before the intervention You will have to take preoperative tests, the same as in any other intervention in which general anesthesia is needed. If you suffer from any important illness, particularly pulmonary or heart diseases, you may need special evaluation before and after the procedure. You must inform your doctor about the medication you are taking or any allergies you suffer. Most medicines can be taken as usual, bur some of them like aspirins, antiaggregates,
anticoagulants, anti-inflammatory agents, corticoids, or insulin must be adjusted before the intervention. It is very important that you inform your dentist that you need antibiotics, as they might be necessary before the exploration. The stomach must be totally empty, so you cannot eat nor drink during the 8 hours prior the exploration. 4. How is a diagnostic laparoscopy performed? General anesthesia is used in this process. The abdominal cavity is punctured with a hollow needle and then gas (carbon dioxide) is introduced in order to distend it. Therefore, a space between the wall and the viscera is created and the surgeons can explore the organs. Through a 10 mm incision (normally in the navel), we introduce a laparoscope, an optic tube connected to a light source and a video system that allows the transmission of images from the inside of the abdominal cavity onto monitors located in the operating room. Some other incisions can be done as well in case more equipment is needed for obtaining a better image or for managing of the organs. In a reduced number of cases it is not possible to complete the exploration with laparoscopy, making it necessary to proceed with open surgery. The surgeon takes this decision following a series of strict safety criteria for the patient and must not be considered a complication by all means. 5. What happens after the intervention? You will stay in the resuscitation room as long as it is necessary until the anesthetic effects are over. Normally, you will be able to eat after 4-6 hours and will be discharged the day after the intervention. You will be given indications about the diet and the medication you must take during the days after the exploration. The results will be told to you at the end of the exploration or in the next appointment with your doctor. If biopsies are taken, those results can be delayed one week. 6. What complications may occur? In spite of the right election and performance of the technique, there can be certain undesirable effects such as those common to all interventions that can affect all organs and systems, but also some others specific to the procedure: - Frequent but not serious: infection or bleeding of the surgical wound, acute retention of urine, phlebitis, temporary digestive disorders, expansion of the gas to the subcutaneous tissue or other areas, and its consequent pains, normally in the shoulder.
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