SECOND LOOK SURGERY

Nuwan Gunapala

Our experience………

43 year old male patient admitted from medical ward with small bowel obstruction

Exploratory laparotomy done Large segment of small bowel was

gangrenous Gangrenous bowel resected and end to

end anastomosis done Viability of ends were not satisfied

during surgery but healthy ends could not be achieved due to risk of short bowel syndrome

Options…..

Achieve the healthy ends and anastomose primarily

Anastomose with best possible bowel ends and avoid the risk of short bowel syndrome but high risk of anastomotic failure…

What to do ?

Definition

Second-look surgery is performed after a procedure or course of treatment to determine if the patient is free of disease.

If disease is found, additional procedures may or may not be performed at the time of second-look surgery.

Indications

To determine if a cancer patient has responded successfully to a particular treatment. ovarian cancer colorectal cancer

1St perform debulking or cytoreduction surgery. This debulking increases the sensitivity of the tumor and decreases the number of necessary treatment cycles.

Following cytoreduction and chemotherapy, a second-look procedure may be necessary to determine if the area is cancer-free

If cancer is found, it may be removed during the procedure or debulk the tumor and improves the response to chemotherapy.

However, second-look surgery cannot definitively prove that a patient is free of cancer; some microscopic cancer cells can persist.

Even if no cancer is found during second-look surgery, the rate of cancer relapse is approximately 25%.

Indications

Intra abdominal bleeding following trauma – damage control surgery

Bowel ischaemia and when doubt on viability of remaining bowel and to check anastomosis

Other indications

Endometriosis Fibroides Subfertility surgery

Timing

Second-look surgery may be done within hours, days, weeks, or months of the initial procedure or treatment.

This time interval depends on the patient's condition and the type of procedure

Surgical options

Laparotomy Laparoscopy

Other instances Arthroscopy. Percutaneous nephrolithotomy Hysteroscopy  Mastoidectomy - second-look procedure is

generally performed to ensure that the entire cholesteatoma was removed during the initial procedure.

Thank you