Laparoscopic Adhesiolysis Periprocedural Care

Updated: Sep 21, 2017
  • Author: Maria Sophia S Villanueva, MD; Chief Editor: Kurt E Roberts, MD  more...
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Periprocedural Care

Preprocedural Planning

Preoperative antibiotics are given in case an enterotomy or bowel resection is needed.

A nasogastric tube in low continuous suction should be placed before and during the procedure, especially for patients with bowel obstruction to ensure that the bowels are decompressed. This allows the surgeon to have adequate space and visualization while performing the procedure.

Preoperative deep venous thrombosis (DVT) prophylaxis is required. Heparin, low-molecular-weight heparin, or sequential antiembolism stockings should be used.

A Foley catheter should be placed to decrease the bladder size and maximize room to work.

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Equipment

At least two video monitors are required. Additionally, the surgeon must be prepared to convert to an open procedure; accordingly, a major abdominal tray should be in the room. The laparoscopic instruments needed include the following:

  • Three to five trocars
  • Angled laparoscopes (30º or 45º)
  • Laparoscopic bowel graspers
  • Laparoscopic shears
  • Laparoscopic energy dissector (of the surgeon's preference)
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Patient Preparation

Anesthesia

General anesthesia is required for all cases. Paralysis is needed to distend the abdomen. In rare cases, high spinal anesthetics may be used.

Positioning

Patients are placed in supine position with both arms tucked. They should be strapped and secured to the bed so they can be placed in Trendelenburg with the left side down to allow visualization of the cecum and to run the bowel, in steep Trendelenburg to allow evaluation of the pelvis, or reverse Trendelenburg to allow evaluation of the upper abdominal cavity. Care should be taken to ensure that patients are adequately padded in areas where there could be pressure, such as the shoulders and arms.

The surgeon should be on the opposite side of where he or she is working. Monitors should be placed on each side and positioned so that they are directly in the line of view of the surgeon operating.

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