Inappropriate Circumstances for Laparoscopic Surgery

Laparoscopy is increasingly selected instead of the laparotomies at the last three decades. The earliest indications of laparoscopies were mostly for gynaecological treatments and cholecystectomies (Cunningham, 1998). Since then, spectrum has been expanding. Increasing laparoscopy experience caused expansion of the indications and, contrary to this, declining the contraindications. So, it can actually be accepted that, in the near future, there will be trace contraindications for laparoscopic procedures. Gastrointestinal operations, especially bowel obstruction treatments are attentive for this trend, thus increased surgical experience and improved surgical instrumentation changed opinions about the most emphasized contraindications for laparoscopic surgery (Reissman & Spira, 2003). Consequently, surgeons who are willing to learn and develop their skills have to observe changes efficiently as laparoscopy indications, contraindications and risks definitions has been changing fast. In a lot of studies, it was proved that surgeons’ experience is the important factor for successful laparoscopies and many obstacles like laparoscopy-related complications, conversion rate, morbidity and mortality rates decreased with increasing experience (Tekkis et al, 2005). As Jansen et al explained, technical improvement and increasing experience in laparoscopy will probably continue to reduce the incidence of surgical complications (Jansen et al, 1997). Soot et al also reported significant decreases in the rates of the problems like conversions and they experienced that conversions rates changed from their first 25 patients to last 25 patients sharply in fundoplication cases (Soot et al, 1999). Problems detected after gaining experience are usually the issues of technical problems and patient-related problems. Contraindications, in other words: not performing laparoscopy and conversions are main aspects of technical and patient related problem that interfere using laparoscopy or completing the laparoscopic attempts. We can easily put forward by evaluating the literature that contraindications will be minimized but if conversions are not focused on, the presence of this aspect may prevent authors from reaching successful laparoscopic results. Therefore, conversions must be evaluated in great attention. Conversion means changing laparoscopic procedure to open procedure because of intraoperative difficulties. Conversions, as mentioned above, can be related to experience but also to technical and patient’s problems. Conversion is not a defeat but choosing the