Laparoscopic Management of Small Bowel Adhesion

Aaradhya Sharma

https://www.laparoscopyhospital.com/SERV01.HTM  This video demonstrates Laparoscopic Management of Small Bowel Adhesion performed by Dr. R.K. Mishra at World Laparoscopy Hospital.  Laparoscopy is safe and feasible in the management of acute SBO in selected patients. It is an excellent diagnostic tool and is therapeutic in most cases. Laparoscopic surgery also has been shown to decrease the incidence, extent, and severity of intra-abdominal adhesions as compared with open surgery, thereby potentially reducing the rate of recurrent adhesive small-bowel obstruction.  For more information please contact:  World Laparoscopy Hospital  Cyber City, Gurugram, NCR DELHI  INDIA 122002  Phone & WhatsApp: +919811416838, + 91 9999677788

Transcript

00:00hello friends this is a case of laparoscopic adhesiolysis for a small bowel adhesions this

00:10patient has repeated episode of sub-acute obstruction for that he has admitted many

00:17time in the hospital actually there is a history of laparoscopic appendicectomy open and after

00:26that we can see the cirrhosa of the adhesion is completely adhered so with the cold seizures first

00:32we will make a pre-peritoneal space because in these cases you should take a portion of the

00:38peritoneum also out with the small bowel because there is a high chance of you know the injury of

00:46the bowel although if injury happen you can do the end-to-end anastomosis or side-to-side anastomosis

00:53with the linear stapler but here we are using cold seizures to make a pre-peritoneal space

00:59so that we can get a plane of dissection and after that with the harmonic you can separate

01:06that entire peritoneum along with the small bowel to prevent the these type of sub-acute recurrent

01:14obstruction so little bleeding is no problem but initial start of the dissection should

01:21be with the cold seizures so now we can see that there is a good plane and with the harmonic

01:28slowly the adhesiolysis will start as we know that 80% of the patient who go for open surgery

01:42they develop adhesions but fortunately 90% of the patient who has adhesions they are asymptomatic

01:49they don't they have only flingy adhesions or the momental adhesions but in this case you

01:55can see a loop of a small bowel almost incarcerated into the abdominal wall and these patients get

02:02repeated sub-acute obstruction and pain abdomen whenever they eat more or some distinctions

02:09gaseous distinctions happen they get pain slowly we are trying to remain in the layers of the

02:16abdominal wall rather going near the cirrhosis and harmonic has advantage that once it vibrates

02:25it vibrates at 55 000 vibrations per second then automatically it gets a plane of dissection

02:32because of breaking of the hydrogen bond so there is a less chances of perforation but of course in

02:39these type of direct cirrhosis of the bubble the chances of perforation cannot be denied so you have

02:48to be very careful and try to remain over the abdominal wall a portion of plutonium also if comes

02:55out with the bubble it is better rather than injuring it a monopolar or bipolar should never be used

03:03because it has a lot of collateral damage and that collateral spread of the heat can create the burn

03:11and subsequently after couple of days there may be perforation due to the thermal injury

03:19so we can see there is a good plane here

03:21and the counter traction gentle counter traction will be given by the atriometric grasper that should

03:33also not be aggressive traction otherwise it can lacerate the bubble and a portion of plutonium is

03:40taken together with the cirrhosis of the bubble

04:10so this is a good plane

04:20so this is a good plane

04:40so now this is just the last part

05:05now the question is this raw area can create re-adhesions

05:14so in this situation we will use inter-seed to prevent the re-adhesion

05:19inter-seed is re-oxygenated cellulose

05:24and that has been reported to prevent adhesion this is a mechanical adhesive barrier

05:35so now it is done after that we will inspect the area carefully to find out any perforation

05:50you should try to handle you should try to press it

05:54we should try this is the distal loop here proximal loop

05:58and you can try to stretch and this area you should try to press it so that

06:03to expect that any fecal matter is coming out or not

06:09so this is okay looks like no problem

06:13this tip you are seeing this is a part of abdominal wall which is adhered with the bubble

06:20that is you can press it to check that if there is you can try to milk it

06:25try to push it in so that you can see that

06:29both the edges you can try to increase because here you cannot do the you know the

06:35any puncture tear test or we cannot inject the air into the intestine to check the

06:40so this way you can press it to check that if there is any perforation so it's fine there is no any

06:46perforation and this raw area can be buried but it is not good to do that because that may create the

06:54structure of that part so let us have one idea that you can put the interseed over

07:01to prevent the adhesion and that entire raw area will be covered with the interseed

07:0715 by 15 interseed is better that get dissolve it soon

07:12so still we are waiting to find out that if something comes out with the manipulation or the pressure

07:22but nothing is there so there is no perforation

07:30so everything look fine

07:31now this is a piece of interseed which will be covered this entire raw area

07:43this patient also postoperatively you have to be little careful

07:48try that they should not have the

07:50immediate

07:55any drink you should try to observe the bubble sound and after that next day you can start feeding the

08:03liquid and subsequently the solid can be started so this entire area we are covering with the interseed

08:12initially interseed looks like a mess but it is not a mess

08:16consistency is just like a tissue paper it is very soft silky

08:21and initially it looks like that it is sticking but after once it become wet then it will be fine

08:28so once it become wet it starts creating jelly-like substance

08:32and that doesn't allow even the inter-bobble loop adhesion to happen

08:37although it right now it looks like solid but it is not because once it get fluid it becomes greasy

08:45the other in the solid state it may stick with some

08:49bubble but as soon as it gets the fluid it will leave that bubble loop away

08:53because it is made for mechanical

08:56adhesive barrier it is made for that purpose

09:00now it's okay we will cover this area

09:04so thank you very much for watching this

09:07a small video this was just a simple case of a small bubble adhesion

09:12with the NTA Admiral wall thank you very much have a nice day

09:21you

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