Bedside Laparoscopy in the Critically Ill: A Review of the Literature
Abstract
:1. Introduction
2. Materials and Methods
3. Indications and Contraindications
- Unexplained sepsis, systemic inflammatory response syndrome, or multiorgan failure;
- Abdominal pain or tenderness associated with other signs of sepsis without an obvious indication for laparotomy;
- Increased abdominal distention that is not a consequence of bowel obstruction;
- Fever or leukocytosis in an obtunded or sedated patient not explained by another identifiable problem;
- Metabolic acidosis not explained by another process.
- Patients unable to tolerate pneumoperitoneum or who are so critical that they have no chance of survival even if a treatable intra-abdominal pathology is found;
- Patients with an already established diagnosis requiring surgical intervention;
- Patients with uncorrected coagulopathy or hypercapnia;
- Patients with suspected abdominal compartment syndrome;
- Patients who have undergone a laparotomy in the last 4–6 weeks;
- Patients with intra-abdominal adhesions secondary to previous surgical interventions (relative).
4. Instrumentation and Setting
5. Anesthesiological Technique
6. Surgical Technique
7. Patients Characteristics and Outcomes
8. Limitations
9. BSL vs. CT Scan
10. Discussion
11. Conclusions
Funding
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Study | Year | Patients | Admission Diagnosis (n) | Positive Findings (%) | Diagnosis (n) | Unnecessary Laparotomy Avoided (%) | Treatment (n) | Mortality (BSL +) |
---|---|---|---|---|---|---|---|---|
Alemanno [14] | 2019 | 129 | Cardiac surgery (90) Sepsis (25) Trauma (14) | 69 (53.5) | Bowel ischemia (40) Bowel hypoperfusion (6) Cholecystitis (13) Bowel perforation (2) Purulent peritonitis (4) Other (4) | 55.0 | Operative (58) Conservative (6) Palliative (5) | 40.6 |
Peris [15] | 2009 | 32 | Cardiac surgery (6) Sepsis (12) Trauma (14) | 15 (46.8) | Cholecystitis (7) Bowel ischemia (1) Bowel perforation (2) Bowel hypoperfusion (2) Purulent peritonitis (3) | 75.0 | Operative (8) PGBD (5) Conservative (2) | 33.3 |
Jaramillo [16] | 2006 | 13 | Sepsis (7) MOF (1) Acute myocardial infarction (2) Intestinal obstruction (1) Bowel ischemia (2) | 9 (69.2) | Bowel ischemia (6) Bowel perforation (1) Cholecystitis (2) | / | Operative (2) Palliative (7) | 77.8 |
Walsh [17] | 1998 | 12 | Cardiac surgery (1) Cardiac (not surgery) (3) Sepsis (5) Respiratory failure (2) Aortic occlusion (1) | 5 (41.6) | Bowel ischemia (2) Sigmoid diverticulitis (1) Terminal ileitis (1) Non-purulent peritonitis (1) | 91.6 | Operative (1) Palliative (4) | 80.0 |
Karasakalides [18] | 2009 | 35 | Trauma (5) Respiratory failure (9) Cardiogenic shock (8) Sepsis (11) Cerebral hemorrage (2) | 15 (42.8) | Bowel ischemia (6) Cholecystitis (5) Biliary peritonitis (1) Purulent peritonitis (2) Mesenteric hemorrage (1) | 82.8 | Operative (11) Palliative (4) | 60.0 |
Hackert [19] | 2003 | 17 | Cardiac surgery (17) | 15 (88.2) | Bowel ischemia (6) Bowel distension (4) Acute cholecystitis (3) Fibrinous peritonitis (1) Acute pancreatitis (1) | / | Operative (14) Conservative (1) | 53.3 |
Sajid [20] | 2018 | 28 | / | 14 (50.0) | Bowel ischemia (7) Cholecystitis (2) Liver ischemia (2) Acute pancreatitis (1) Gangrenous uterus (1) Gastric volvulus (1) | 82.1 | Opertive (8) Conservative (3) Palliative (3) | / |
Bergamini [21] | 2022 | 43 | Cardiac surgery (43) | 13 (30.2) | Bowel ischemia (13) | 69.7 | / | 46.1 |
Pecoraro [22] | 2001 | 11 | Sepsis (4) Intestinal perforation (3) Bowel ischemia (1) Thoracic surgery (1) Diabetic ketoacidosis (1) Jaundice (1) | 6 (54.5) | Duodenal perforation (1) LUQ abscess (1) Large pelvic mass (1) Cirrhosis (1) Bowel ischemia (1) Colo-vesical fistula (1) | 63.6 | Operative (4) Percutaneous drainage (1) Conservative (1) | 50.0 |
Ceribelli [23] | 2012 | 62 | Cardiac surgery (38) Vascular surgery (13) Trauma (6) Sepsis (3) Neurosurgery (2) | 43 (69.3) | Cholecystitis (29) Bowel ischemia (5) Diaphragmatic rupture (3) Perforated peptic ulcer (2) Minor hepatic/splenic injury (2) Aorto-aortic anastomosis leak (2) | 30.6 | Operative (43) | 48.8 |
Kelly [24] | 2000 | 17 | Cardiac surgery (7) Vascular surgery (3) Trauma (2) Neurosurgery (1) Urologic surgery (1) ESRD (1) Cardiac (not surgery) (1) Respiratory failure (1) | 6 (35.3) | Bowel ischemia (4) Cholecystitis (2) | 70.6 | Operative (6) | 50.0 |
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Palladino, A.; Vallicelli, C.; Perrina, D.; Convertini, G.; Coccolini, F.; Ansaloni, L.; Sartelli, M.; Catena, F. Bedside Laparoscopy in the Critically Ill: A Review of the Literature. J. Clin. Med. 2024, 13, 1530. https://doi.org/10.3390/jcm13061530
Palladino A, Vallicelli C, Perrina D, Convertini G, Coccolini F, Ansaloni L, Sartelli M, Catena F. Bedside Laparoscopy in the Critically Ill: A Review of the Literature. Journal of Clinical Medicine. 2024; 13(6):1530. https://doi.org/10.3390/jcm13061530
Chicago/Turabian StylePalladino, Alessandro, Carlo Vallicelli, Daniele Perrina, Girolamo Convertini, Federico Coccolini, Luca Ansaloni, Massimo Sartelli, and Fausto Catena. 2024. "Bedside Laparoscopy in the Critically Ill: A Review of the Literature" Journal of Clinical Medicine 13, no. 6: 1530. https://doi.org/10.3390/jcm13061530
APA StylePalladino, A., Vallicelli, C., Perrina, D., Convertini, G., Coccolini, F., Ansaloni, L., Sartelli, M., & Catena, F. (2024). Bedside Laparoscopy in the Critically Ill: A Review of the Literature. Journal of Clinical Medicine, 13(6), 1530. https://doi.org/10.3390/jcm13061530