1. LAPAROSCOPIC SURGERY
AGUS SUPRIADI

2. INTRODUCTION SYNONYM KEY HOLE SURGERY BUTTON HOLE SURGERY
MINIMALLY INVASIVE SURGERY
MINIMAL ACES SURGERY

3. HISTORY
1983 : First laparoscopic appendicectomy by Kurt Semm , German gynecologist
1985 : First laparoscopic cholecystectomy by Erich Muhe, German surgeon
1987 : first laparoscopic repair of inguinal hernia by Ger
1991 : Ibrahim Ahmadsyah,first laparoscopic in Jakarta

4. FREQUENTLY DONE PROCEDURE
ABDOMEN:
Cholecystectomy incld Exploring CBD
Appendicectomy
Hernia Repair
Adhesiolysis
Diagnostic
Bariatric/Sleeve Gastrectomy
Colorectal tumour
Fundoplication
Achalasia

5. CHOLECYSTECTOMY Indications: Cholelithiasis Mucocele gallbladder
Empyema gallbladder
Thypoid carrier
Porcelain gallbladder
Acute cholecystitis

6. CHOLECYSTECTOMY Contraindications: Hemodynamic instability
Uncorrected coagulopathy
Generalized Peritonitis
Severe cardiopulmonary disease
Abdominal wall infection
Multiple previous upper abdominal procedures
Late pregnancy

7. CHOLECYSTECTOMY Advantage : Cosmetically better outcome
Less tissue disection
Less pain postoperatively
Low intraoperative and postoperative complications
Early return to work

8. APPENDICECTOMY Indications for laparoscopic :
Female of reproductive age group
Female of premenopausal group
Suspected appendicitis
High working class
Previous lower abdominal surgery
Obese patients
Disease conditions like cirrhosis
Immune compromised patients

9. APPENDICECTOMY Indications for Open Surgery Complicated appendicitis
COPD or Cardiac disease
Generalized peritonitis
Stump appendicitis after previous incomplete appendicectomy

10. RISK FACTOR IN LAPAROSCOPIC APPENDICECTOMY
Missed Diagnosis
Bleeding
Visceral Injury
Wound Infection
Incomplete Appendicectomy
Leakage of Purulent Exudates
Intra Abdominal Abscess
Hernia

11. INGUINAL HERNIA REPAIR
Indications :
Bilateral Inguinal Hernias
Recurrent Inguinal Hernias
Contraindications :
Non reducible,incarcerated inguinal hernia
Prior laparoscopic hernioraphy
Massive scrotal hernia
Prior pelvic lymph node disection
Prior groin irradiation

12. INGUINAL HERNIA REPAIR
Advantages of laparoscopic repair:
Tension free repair that reinforces myopectoneal orrifice
Less tissue disection
Less pain postoperatively
Low intraoperatively and postoperatively complication
Early return to work

13. Types of Laparoscopic Hernia Repair
Simple closure of the internal rings
Plug and patch repair
Intraperitoneal onlay mesh repair
Transabdominal pre peritoneal mesh repair (TAPP)
Total Extra peritoneal repair (TEP)

14. COMPLICATIONS OF LAPAROSCOPIC HERNIA REPAIR
Recurrence
Neurovascular injury
Urinary tract injury
Iinjury to vas
Testicular complications
Problem due to mesh

15. LAPAROSCOPIC ADHESIOLYSIS
Peritoneal adhesion is a common cause of bowel obstruction,pelvic and infertility Normal fibrinolytic activity prevents fibrinous attachments for 72 to 96 hours after surgery and mesothelial repair occurs within 5 days of trauma

16. The most important factors which suppress fibrinolytic activity and promote adhesion formation are :
Port wound just above the target of dissection
Tissue ischemia
Drying of serosal surfaces
Excessive suturing omental patches
Traction of peritoneum
Blood clots, stones or dead tissue retained inside

17. Prolonged operation
Visceral injury
Infection
Delayed postoperative mobilization of patient
Postoperative pain due to inadequate analgesia

18. DIAGNOSTIC LAPAROSCOPY
1.Non traumatic,Non gynecologycal,Acute Abdomen like :
Appendicitis
Diverticulitis
Mesenteric Adenitis
Intestinal Adhesion
Omental Necrosis
Intestinal Infarction
Complicated Meckel’s diverticulum
Torsion of intra abdominal testis

19. 2.Gynecological Abdominal Emergencies like :
Ovarian cyst
PID
Acute salpingitis
Ectopic pregnancy
Endometriosis
Perforated uterus due to criminal abortion

20. CONTRAINDICATIONS Hemodynamic instability
Mechanical or paralytic ileus
Uncorrected coagulopathy
Generalized peritonitis
Severe cardiopulmonary disease
Abdominal wall infection
Multiple previous abdominal procedures

21. LAPAROSCOPIC FUNDOPLICATION
Gastroesophageal reflux disease (GERD) is defined as the failure of the anti reflux barrier, allowing abnormal reflux of gastric content into the esophagus.
Symptoms :
Heartburn (retosternal burning ) 5-45% of adult in western countries
Regurgitation

22. Pain
Respiratory symptoms
Diagnostic Test :
Endoscopy
Barium swallow
Esophageal manometry
pH monitoring

23. TREATMENT OF GERD Medical Therapy
Esophagitis will heal approx 90% with intensive medical theraphy
Symptoms recur more than 80% within one year of drug withdrawal
Chronic condition , medical theraphy involving acid suppresion and pro motility agents may be required for the rest of patient’s life

24. 2.Surgical Therapy
Should be considered in individuals :
Refractory to medical management
Associated with hiatus hernia
Intolerance to PPH or H2 receptors
Not compliant to medical therapy
Have complications of GERD , e.g Barrett’s esophagus,stricture, grade 3 or 4 esophagitis
Atypical symptoms like : asthma,hoarseness,cough,chest pain and aspiration

25. METHODS OF FUNDOPLICATION
The classical open methods
The modern Laparoscopic techniques

26. Types of Laparoscopic Fundoplication
Nissen Fundoplication
Toupet Fundoplication
Dor Fundoplication

27. THANK YOU