2ND-LOOK LAPAROSCOPY AFTER MESENTERIC INF ARCTION

Second-look laparotomy is not always routinely performed after mesente ric infarction. Such operations are often not performed because of the high operative risk in aged patients and those with cardiovascular di sease. We developed a minimally invasive technique, for second-look la paroscopy with the aim of decreasing the operative morbidity. With the patient under general anaesthesia, the old incision is opened at the umbilicus. The running suture in the abdominal wall is lifted with a c lamp and the incision line is gently reopened. A trocar with a blunt t ip designed for open laparoscopy is then inserted and fixed. Following insufflation of CO2 through the trocar it is possible to explore the entire small bowel and colon. We operated on five patients after bowel resection performed for mesenteric infarction. Second-look laparoscop y was diagnostic in all but one, in whom laparoscopy failed due to mas sive small bowel dilatation. The technique described here is very prom ising and deserves further evaluation.