Intestinal Laparoscopic Surgery
These procedures now include resections of the small intestine and colon. Appendectomy (removal of the appendix), which used to require a small incision in the abdomen, can now be performed laparoscopically. There are several benefits, one of which is the ability to assess the abdomen for other problems should the appendix appear normal. There may also be some advantage to performing an appendectomy laparoscopically since it has been shown to be associated with slightly decreased hospital stay and faster recovery.
Colon procedures are performed laparoscopically, however an incision is still necessary to deliver the bowel specimens and re-establish the bowel outside of the abdomen. The advantages again are decreased pain and faster recovery. Colon resections are somewhat more elaborate and the advantages are not as dramatic as the other procedures mentioned above.
Other problems which have been approached laparoscopically include hernia repair. Hernias are generally repaired through a small incision in the groin usually with placement of a mesh. A laparoscopic approach to the groin is usually performed just below the umbilicus and performed either through the abdomen or just outside the abdominal cavity (pre-peritoneal). This pre-peritoneal approach is theoretically safer since it never exposes any mesh to bowel which may become adherent to it. Placement of this mesh is achieved laparoscopically and fixed into place with a stapler. There are advantages to this procedure; more rapid return to full activity and work. There seems to be decreased pain post-operatively with a laparoscopic approach and also, assessment of an asymptomatic side is possible laparoscopically. Most commonly, a laparoscopic approach is used for recurrent hernias which have failed an open incision approach, or bilateral hernias. Primarily repair through a laparoscopic route is now becoming more common for all hernia types.