Laparoscopic reintervention in colorectal surgery.

Laparoscopic colorectal surgery has developed in the 1990's and beginning of 2000. The favourable results and great progress in the development of laparoscopic techniques have expanded the indications of laparoscopic colorectal surgery. More and more complicated colorectal cases are treated laparoscopically, including those having had previous laparotomies. Surgical reinterventions after colorectal procedures are common. Reinterventions are either intended to treat complications of colorectal surgery or to treat colorectal disease after previous abdominal or pelvic surgery. Laparoscopic reinterventions face surgeons with specific challenges related to morphological changes in the abdomen. Adhesions are primarily responsible for these changes and evoke various complications such as trocar injury, bleeding, enterotomy and conversion to laparotomy. Trocars and Veress needle are responsible for up to half of all bowel injuries in laparoscopic surgery and adhesion formation is the most important risk factor for bowel injury. The risks of adhesions are often underestimated. The first clinical results on laparoscopic reinterventions are promising. Routine use of anti-adhesion agents and diagnostics is advocated to prevent adhesion formation and make reintervention more safe reducing serious complications as inadvertent enterotomy, bleeding and trocar injuries. More research is needed to develop better tools for mapping adhesions, as none of the trocar placing techniques can rule out bowel injury. Improved diagnostic tools for mapping adhesions will also facilitate patient selection for laparoscopic treatment of SBO.