The laparoscopic second look for ischemic bowel disease

Background: Survival after acute vascular ischemia depends on a second look laparotomy to detect extending bowel compromise and to verify the integrity of the anastomosis. In a series of five consecutive patients with acute ischemic bowel desease, we used laparoscopic technique to determine if a formal laparotomy could be avoided. Methods: following the resection of ischemic bowel in five consecutive patients, two laparoscopic trocars were inserted in the lower abdominal quadrants and covered by sterile gloves. Forty-eight to 72 h following the primary operation, the abdomen was inflated via a trocar and secondary assessement done by laparoscopy. Results: In all patients, the integrity of the anastomosis and viability of the remaining bowel was accurately assessed by laparoscopy. Conclusions: Using mininally invasive techniques, a second look laparotomy was avoided in 5 patients with ischemic bowel disease.