Postoperative Management
Laparoscopy has facilitated the outpatient management of many abdominal procedures, including the cholecystectomy, bariatric surgery such as the adjustable gastric band, Nissen fundoplication and Heller myotomy, diagnostic exploration, and in some cases, ventral or incisional hernia repair. In some cases, even the presence of a larger incision used for tissue extraction may allow retention of all the recovery benefits of laparoscopy. Relative increased peak pressures during laparoscopy may make postoperative pulmonary care more essential, but less difficult due to decreased splinting. The risk of ileus is generally reduced, as well as narcotic use, so diets can be advanced also immediately. The convalescent period is minimal in most cases, and two weeks is an adequate time before resumption of full activity.
Complications
The complications specific to laparoscopy are generally related to its inherent technical challenges and the physiologic effects of pneumoperitoneum. Reduced visualization and dexterous limitations may increase the risk of organ injury that may go seen, or unseen. Pneumoperitoneum with carbon dioxide to a standard pressure between 10 to 15 mmHg can predisopose to hypercarbia, reduced cardiac output, pneumothorax, or air embolus.
Postoperatively, retained carbon dioxide may serve as a diaphragmatic irritant, and referral of pain to the ipsilateral shoulder can be severe, but rarely lasting beyond 36 hours. Port site infections occur on a rare basis and can usually be treated expectantly. Hernias do occur at port sites, and are more common with ports greater than 5 mm in size, or where manipulation, replacement, or frequent torqueing on the port is common.
