Brief Useful Comments on Laparoscopic Surgery in Acute Abdomen.

The use of laparoscopic surgery tends to become more and more popular, nowadays. It has also been extended in the management of acute abdominal disease as a diagnostic and as a therapeutic tool. However, its therapeutic use requires special experience and appropriate instrumentation, in addition to a reliable definite diagnosis. Based on randomized, controlled trials, it can be postulated that laparoscopic surgery in acute abdomen is feasible, safe and effective in acute cholecystitis, acute appendicitis and gastroduodenal ulcer perforation. There are still conflicting aspects in perforated diverticular disease and small bowel obstruction. In case of purulent peritonitis attention must be paid in order to avoid residual abscess formation and sepsis by thorough irrigation of the peritoneal cavity and on time antibiotic therapy. The proper indication for each case under the certain emergency circumstances is crucial.

Prevention of Anastomotic Leakage in Gastrointestinal Tract: A Brief Literature Review.

Anastomotic leakage and its consequences in gastrointestinal tract surgery, especially in low anterior resection, is a day major complication affecting morbidity and mortality rate. Early detection and prevention is crucial in order for sepsis to be avoided. There are well-defined risk factors influencing anastomosis healing. The patient’s status and operative conditions including surgical technique have been incriminated for dehiscence. The correct application of conventional operative principles is important. The outcome of anastomosis either handsewn or stapled is deemed to have no major difference. Novel compression anastomotic instruments have been proposed as an alternative option, yet without wide broad application and enough experience. There are innovative staple line reinforcement materials. Some topics such as proximal defunctioning stoma, pelvic tubes or the recently proposed transanal drainage tube are in debate for routine or selective use. Protective transverse colostomy does not affect the risk of leakage, but it reduces the septic consequences. Laparoscopic procedures have similar anastomotic leakage rate with open operations. There is no consensus on whether covering anastomosis with great omentum is necessary as protection or for mechanical bowel preparation. Novel promising perspectives exist as well as commonly accepted aspects. The combination of conventional techniques (handsewn or stapled anastomosis performance) with modern techniques may be proved effective in reducing anastomotic leakage rates.