Minimally invasive ‘second look’ in the era of laparoscopic surgery

Case report


Keith Hussey, Kieran Chircop, Abdulmajid Ali

Department of General Surgery, Ayr Hospital’ Dalmellington Road , Ayr, UK

IJMBS 2010, 2(3):129-132


The benefits associated with minimally invasive surgery, in both elective and emergency practice are well established. In recent years the concept of damage control surgery has been embraced and gained increasing popularity. We describe a modification of an already described technique in the context of the ‘second look’ in the era of laparoscopic surgery.
A seventy year old patient with type one respiratory failure presented with an acute abdomen. Pre-operative imaging suggested mesenteric ischaemia and a decision was made to proceed with laparoscopic surgical intervention. An infarcted small bowel segment was identified and resected. A primary anastomosis was constructed, but in view of the underlying pathological process it was felt that a ‘second look’ was required. This was facilitated by leaving an 11mm port in left lower quadrant after the primary procedure, so that twenty four hours post-operatively the anastomosis could be inspected.
The concept of the ‘second look’ is well established and in the context of mesenteric ischaemia and a laparoscopic ‘second look’ following open surgery, previously described. We have embraced the ‘second look’ concept and were able to perform both procedures in a minimally invasive fashion.

Keywords: Mesenteric ischaemia; laparoscopy; second look