**11. References**


Although most studies are retrospective, this conservative approach has a clear advantage. However, there is a consensus on the fact that laparoscopic washing and drainage is not recommended for cases of fecal peritonitis, and the results are unsatisfactory for cases of formation of an abscess in the pelvis. Several prospective and randomized studies are being conducted in order to better define in which clinical situations this approach should be

Access by laparoscopy seems to be of advantage over laparotomy as a diagnostic and therapeutic method in the approach to peritonitis and sepsis of abdominal origin by involving a lower surgical trauma, by providing a good field of view of the peritoneal cavity and by permitting to obtain tissue and fluid samples under direct vision. The rate of unnecessary laparotomies can be reduced when laparoscopy is used for a diagnostic and therapeutic approach in cases of acute abdomen, even in the presence of peritonitis or sepsis

In the management of peritonitis by laparoscopy, the inflammatory response is milder compared to management by laparotomy. The elevation of inflammatory cytokines is moderate and macrophages present a better basal immunologic performance. In contrast to what occurs with laparotomy, the acute phase of the inflammatory response associated with perioperative sepsis is attenuated during laparoscopy, and the immune function seems to be

Despite the doubts about the feasibility and efficiency of laparoscopy compared to laparotomy for the approach to peritonitis, minimally invasive surgery is gaining acceptance

Almeida J, Sleeman D, Sosa JL, Puente I, McKenney M & MartinL. (1995). Acalculous

Balague C, Targarona EM, Pujol M, Fillela X, Espert JJ & Trias M. (1999). Peritoneal response to

laparoscopy, and wall lift laparoscopy. *Surg Endosc*, Vol.13, pp. (792–796). Bloechle C, Emmermann A, Strate T, Scheurlen UJ,Schneider C, Achilles E, Wolf M, Mack D,

Boyd WP Jr & Nord HJ (2000). Diagnostic Laparoscopy. *Endoscopy*, Vol. 32, No.2, pp. (153-158) Brandt CP, Priebe PP & Eckhauser ML. (1993). Diagnostic laparoscopy in the intensive care

cholecystitis: the use of diagnostic laparoscopy. *J Laparoendosc Surg,* Vol. 5, pp. (227–

a septic challenge comparison between open laparotomy, pneumoperitoneum

Zornig C & Broelsch CE (1998). Laparoscopic versus open repair of gastric perforation and abdominal lavage of associated peritonitis in pigs. *Surg Endosc,* Vol*.* 

patient. Avoiding the nontherapeutic laparotomy. *Surg Endosc* , Vol. 7, No.3, pp. (168-

among surgeons, especially regarding patients with abdominal sepsis.

Financial support: Fundação Waldemar Barnsley Pessoa

indicated (Toorenvliet et al., 2010).

**9. Conclusion** 

of abdominal origin.

better preserved after the latter.

**10. Acknowledgments** 

**11. References** 

231).

172).

12, pp. (212–218).


Laparoscopic Approach to Abdominal Sepsis 235

Navez B, d'Udekem Y, Cambier E, Richir C, de Pierpont B & Guiot P. (1995). Laparoscopy for management of nontraumatic acute abdomen. *World J Surg*, Vol. 19, (382–386). Orlando R III & Crowell KL. (1997). Laparoscopy in the critically ill. *Surg Endosc*, Vol. 11, pp.

Ou CS & Rowbotham R. (2000). Laparoscopic diagnosis and treatmentof nontraumatic acute abdominal pain in women. *J Laparoendosc Adv Surg Tech A,* Vol.10, pp (41–45). Pamoukian VN & Gagner M.(2001). Laparoscopic necrosectomy for acute necrotizing pancreatitis. *J Hepatobiliary Pancreatic Surg*, Vol. 8, No. 3, pp. (221-223). Pecoraro AP, Cacchione RN, Sayad P, Williams ME & Ferzli GS. (2001). The routine use of

Perri SG, Altilia F, Pietrangeli F, Dalla Torre A, Gabbrielli F, Amendolara M, Nicita A, Nardi M

Poulin EC, Schlachta CM & Mamazza J. (2000). Early laparoscopy to help diagnose acute

Salgado Jr W, Santos JS &Cunha FQ (2008) The effect of laparoscopic Access and antibiotics on

Sanna A, Adani GL, Anania G & Donini A. (2003). The role of laparoscopy in patients with

Sauerland S, Agresta F, Bergamaschi R, Borzelino Z, Budzynski A, Champault G, Fingerhut A,

Association for Endoscopic Surgery (EAES). *Surg Endosc*, Vol. 20, pp.(14-29). Scott-Coombes Dm, Vinpond MN & Thompson JM. (1993). General surgeons attidues to the

So¨zu¨er EM, Bedirli A, Ulusal M, Kayhan E &Yilmaz Z. (2000). Laparoscopy for diagnosis and

Spirt MJ. (2010). Complicated intra-abdominal infeccions: a focus on appendicitis and

Stefa´nsson T, Nyman R, Nilsson S, Ekbom A & Pa'hlman L. (1997). Diverticulitis of the

Stefanidis D, Richardson WS, Chang L, Earle DB & Fanelli RD. (2009). The role of diagnostic

Targarona EM, Balagué C, Espert JJ, Pérez Ayuso RM, Ros E, Navarro S, Bordas J, Téres J, &

Targarona EM, Rodr´guez M, Camacho M, Balagué C, Gich I, Vila L & Trias M. (2006).

and limitations. *Chir Ital*, Vol. 54, No. 2, pp. (165-178).

*Surgery Techniques,* Vol.18, No.1, pp.( 5-12).

*Surgeons of England*, Vol. 75, pp. (123-128).

diverticulitis. *Postgrad Med*, Vol. 122, No.1, pp. (39-51).

surgery. *Surg Endosc*, Vol. 20, No. 2, pp. (316–321).

*A*, Vol.13, pp. (17–19).

Vol. 38, pp. (313-319).

Vol. 23, pp. (16-23).

No. 4, pp. (365-368).

207).

nonspecific abdominal pain. *Lancet*, Vol. 355, pp. (861–863).

diagnostic laparoscopy in the Intensive Care Unit. *Surg Endosc,* Vol. 15, pp. (638–641).

Jr, Lotti R & Citone G. (2002). Laparoscopy in abdominal emergencies. Indications

the outcome of severe bacterial peritonitis in rats. *Journal of Laparoscopy and Advanced* 

suspected peritonitis: experience of a single institution. *J Laparoendosc Adv Surg Tech* 

Isla A, Johansson M, Lundorff P, Navez B, Saad S & Neugebauer EA. (2006). Laparoscopy for abdominal emergencies: evidence-based guidelines of the European

treatment and prevention of abdominal adhesions. *Annals of the Royal College of* 

treatment of acute abdominal pain. *J Laparoendosc Adv Surg Tech A*, Vol. 10, pp. (203–

sigmoid colon: a comparison of CT, colonic enema, and laparoscopy. *Acta Radiologica*,

laparoscopy for acute abdominal conditions: an evidence based review. *Surg Endosc*,

Trias M. (1995). Laparoscopic treatment of acute biliary pancreatitis. *Int Surg* , Vol. 80,

Immediate peritoneal response to bacterial contamination during laparoscopic

(1072–1074)


Gamal EM, Metzger P, Szabo G, Brath E, Peto K, Olah A, Kiss J, Furka I & Mikó I. (2001). The

Geis WP & Kim HC. (1995).Use of laparoscopy in the diagnosis and treatment of patients with

Golash V, Willson PD. Early laparoscopy as a routine procedure in the management of acute abdominal pain: a review of 1,320 patients. *Surg Endosc*. 2005;19(7):882–885 Gurtner GC, Robertson CS, Chung SCS, Ling TKW, Ip SM & Li AKC (1995). Effect of carbon

Hackert T, Kienle P, Weitz J, Werner J, Szabo G, Hagl S, Bu¨chlerMW & Schmidt J. (2003).

Hemmila MR, Birkmeyer NJ, Arbabi S, Osborne NH, Wahl WL & Dimick JB. (2010).

Hori Y. (2008). SAGES Guidelines Committee. Diagnostic laparoscopy guidelines: This

Endoscopic Surgeons (SAGES). *Surg Endosc.* Vol. 22, No. 5, pp. (1353-1383). Jaramillo EJ, Trevino JM, Berghoff KR & Franklin ME Jr. (2006). Bedside diagnostic

Kelly JJ, Puyana JC, Callery MP, Yood SM, Sandor A & Litwin DE. (2000). The feasibility and

Kirshtein B, Roy-Shapira A, Lantsberg L, Mandel S, Avinoach E & Mizrahi S. (2003). The use of laparoscopy in abdominal emergencies. *Surg Endosc*, Vol. 17, pp. (1118–1124). Landercasper J, Cogbill TH, Merry WH, Stolle RT & Strutt PJ. (1993). Long-term outcome after hospitalization for small-bowel obstruction. *Arch Surg*, Vol. 128, pp.(765-770). Linhares L, Jeanpierre H, Borie F, Fingerhut A & Millat B. (2001). Lavage by laparoscopy fares

Llanio R & Sarle H. (1956). Interet de La peritoneoscope chez politraumatises. *Marseille Chirurg*,

M. L. Druart, R. Van Hee, J. Etienne, G. B. Cadie`re, J. F. Gigot, M. Legrand, J. M. Limbosch, B.

Majewski W. (2000). Diagnostic laparoscopy for the acute abdomen and trauma. *Surg Endosc*,

Nagle A, Ujiki M, Denham W & Murayama K. (2004). Laparoscopic adhesiolysis for small

multicenter clinical trial. *Surgical Endoscopy*, Vol. 11, pp. (1017–1020)

bowel obstruction. *Am J Surg*, Vol. 187, No. 4, pp. (464-470).

surgical abdominal sepsis. *Surg Endosc,* Vol.9, pp. (178–182).

after cardiac surgery. *Surg Endosc*, Vol.17, pp. (1671–1674)

peritonitis. *Br J Surg*, Vol. 82, pp. (844–848).

877).

945).

159).

(617–621).

pp. (85–89).

Vol. 8, pp. (82-86).

Vol. 14, pp. (930–937).

influence of intraoperative complications on adhesion formation during laparoscopic and conventional cholecystectomy in an animal model. *Surg Endosc*, Vol. 15, pp.(873-

dioxide pneumoperitoneum on bacteraemia and endotoxaemia in an animal model of

Accuracy of diagnostic laparoscopy for early diagnosis of abdominal complications

Introduction to Propensity Scores. A case study on the comparative effectiveness of laparoscopic vs open appendectomy. *Archives of Surgery*, Vol. 145, No. 10, pp. (939-

guideline was prepared by the SAGES Guidelines Committee and reviewed and approved by the Board of Governors of the Society of American Gastrointestinal and

laparoscopy in the intensive care unit: a 13-year experience. *JSLS*, Vol.10, pp. (155–

accuracy of diagnostic laparoscopy in the septic ICU patient. *Surg Endosc*, Vol. 14, pp.

better than lavage by laparotomy: experimental evidence. *Surg Endosc*, Vol. 15, No. 1,

Navez, M. Tugilimana, E. Van Vyve, L. Vereecken,3 E & Wibin, J. P. (1997). Yvergneaux Laparoscopic repair of perforated duodenal ulcer. A prospective


**15** 

*USA* 

**Role of Endoscopy in** 

*Mayo Clinic Jacksonville* 

**Laparoscopic Procedures** 

Mohamed O. Othman, Mihir Patel and Timothy Woodward

Endoscopy is a viable tool in the diagnosis and management of various gastrointestinal disorders. In this chapter we will discuss the role of Endoscopy in facilitating laparoscopic procedures. Endoscopy can be done before, during or after the laparoscopic procedures and can be an alternative management technique for laparoscopy. We will focus on the recent

Accurate localization of the surgical site is crucial prior to laparoscopic resection. Flat colorectal polyps or cancer are often hard to localize by visualization of the colonic wall or even by palpation. Measuring the distance of the lesion from the anal verge or correlating with a barium enema is usually not accurate enough for localizing the segment prior to colonic resection. Intra-operative colonoscopy is accurate in localizing the lesions, but it might interfere with patient positioning or laparoscopic field by air insufflation; in addition

Endoscopic tattooing of the lesion prior to laparoscopic resection has proven to be accurate and efficient. Feingold et al in a retrospective study of 50 patients who underwent endoscopic tattooing prior to laparoscopic resection found that 88% of these lesions were accurately localized during the laparoscopic procedure; no complications were reported.[1] Many agents have been studied for use in endoscopic tattooing. Methylene blue and indigo carmine can successfully stain the serosa. However, these agents disappear in few days, making it not suitable for endoscopic tattooing. [2,3] Indian ink, however, can stain the serosa for years making it the ideal agent for tattooing [4]. Indian ink should be sterilized and diluted prior to injection [5]. A prepackaged sterilized and already diluted Indian ink, SPOT® (GI Supply, Camp Hill, Pennsylvania, USA) is currently used by many endoscopists for endoscopic tattooing [6]. It is recommended to inject the tattoo in 3 circumferential sites distal to lesion in case one of these sites is on the mesenteric side of the colon [4] The longterm safety of Indian ink was evaluated in a study of 55 patients; no clinical complications such as fever, infection or abdominal pain were reported. There was mild chronic inflammation at the site of injection in 6 patients without clinical significance[7]. Intraperitoneal spillage of Indian ink can happen and it is usually without clinical

**1. Introduction** 

advances in the frontier and what the future holds.

**2.1 Tattooing prior to laparoscopic resection** 

to prolonging the procedure time looking for the lesion.

**2. Endoscopy prior to laparoscopy** 

