Perioperative management - diagnostic laparoscopy for adhesion zone, lavage cytology, biopsy sampling, second look operation

• Assessment of tumor recurrences
• Evaluation of therapeutic success
• Prevention or treatment of adhesions
• Suspicion of suture insufficiency, abscesses, or bleeding
• Evaluation in case of suspected remaining infection sites
• Evaluation of intestinal or vascular anastomoses
• Evaluation for remaining endometriosis sites
• Planned reoperation: If the initial surgery could not be completed due to time or complication reasons, e.g., in tumor removals.

Second-look operations thus serve to review and, if necessary, improve a first operation, especially in complicated cases or oncological patients.

• History: Pre-existing conditions, medication intake (e.g., anticoagulants)
• Fasting: at least 6 hours before the operation
• Preoperative laboratory tests: blood count, coagulation status, electrolytes (depending on the patient)
• ECG, possibly chest X-ray (for high-risk patients)
• Discontinuation/adjustment of certain medications (e.g., blood thinners)
• Preoperative antibiotic prophylaxis (if needed)

• Explanation of the Procedure: Diagnostic laparoscopy is used to examine the abdominal cavity using a camera through small incisions.
• Indication: Explanation of the reason for the procedure, e.g., unclear abdominal pain, suspicion of tumors, endometriosis, adhesions, etc.
• Alternative Procedures: Mention of possible alternatives such as CT, MRI, or ultrasound, if applicable.

Procedure Course

• Incision Technique: Smaller skin incisions (usually in the navel area), or in the area of the Palmer's point if adhesions are suspected. Additional incisions if necessary for the introduction of instruments.
• Gas Insufflation: Use of CO₂ gas to create pneumoperitoneum for better visibility in the abdominal cavity.
• Duration: Explanation that the duration can vary, but usually lasts 30–90 minutes.
• Anesthesia: Performed under general anesthesia, explanation of anesthesia risks.
• Risks and Complications
• General Surgical Risks: Bleeding, infections, wound healing disorders, scar formation.
• Injury to Internal Organs: Possible injury to the intestine, bladder, blood vessels, or other abdominal organs.
• Gas Embolism: Very rare but possible complication due to CO₂ gas.
• Thrombosis/Embolism: Risk factors for blood clot formation.
• Need for Conversion to Open Surgery (Laparotomy): If visibility is poor or complications arise.
• Postoperative Complaints: Shoulder pain due to CO₂ residues, nausea, abdominal pain.
• Postoperative Measures
• Pain Management: Possible need for pain medication.
• Restrictions: Physical rest for a few days, no heavy lifting or sports activities.
• Follow-up Care: Possibly removing stitches, wound control, and regular doctor visits to monitor recovery.

Prospects of Success and Limitations

• Diagnostic Accuracy: Note that a definitive diagnosis cannot always be made.
• Therapeutic Interventions: Possibility that small therapeutic measures (e.g., releasing adhesions, biopsies) can be performed during laparoscopy if a finding is made.

Consent

• Voluntariness: The patient must understand that they are undergoing the surgery voluntarily and can withdraw consent at any time.
• Documenting the Consultation: The consultation must be thoroughly documented, and the patient must give their consent in writing.

This detailed explanation ensures that the patient fully understands the risks, benefits, and alternatives of laparoscopy.