Indications, advantages and disadvantages

The indications why an abdominal endoscopy (laparoscopy) should be performed are very diverse. Probably the most common indication for the use of laparoscopy is the removal of the appendix of the actual appendix (caecum). Only 10 years ago, the removal of the inflamed appendix required a deep open incision at the side of the abdomen and then the appendix was removed in an open surgery where the intestine could be seen directly.

This had the disadvantage that the cosmetic result was not very nice in retrospect, but also that an open abdominal cavity always offers a larger surface for germs and bacteria to attack. With the help of laparoscopic surgery, i.e. surgery by means of laparoscopy, not only can a better cosmetic effect be achieved, but the risk of infection is also reduced. In addition, laparoscopic surgery can use a local anaesthetic, which means that patients are fit again more quickly and can leave the hospital more quickly, although general anaesthesia is still used for laparoscopy.

Laparoscopy is also very popular for the surgical removal of the gall bladder (cholecystectomy). The gall bladder must be removed, especially in the case of inflammation of the gall bladder or, for example, in the case of an infestation by Samonella thyphia, i.e. the bacteria that cause typhoid fever. Since many patients do not wish to have a transverse scar across the entire upper abdomen, which would inevitably result from an open removal of the gall bladder, laparoscopy together with minimally invasive surgery is the method of choice here (so-called gold standard).

Depending on the severity and type of cause, various intestinal diseases can also be treated by means of laparoscopy and minimally invasive surgery. For example, intestinal polyps are often removed by means of laparoscopy under general anesthesia. Nevertheless, it should be said at this point that laparoscopy together with minimally invasive surgery does not only have advantages.

Because the doctor inserts the instruments and the camera through a small hole in the abdominal wall, he cannot spontaneously enlarge the surgical area if this should be necessary. In addition, he cannot detect possible abnormalities by touching the intestinal section to be examined. This means that the doctor loses an important tool, namely his sense of touch and feeling.

For this reason, there are many areas, for example in tumour removal, where open surgery is clearly preferable to laparoscopy. Even adhesions in the abdominal cavity can only be removed laparoscopically, i.e. by means of laparoscopy, to a certain extent. Laparoscopy is particularly important in the field of gynaecology.

Here, laparoscopy is a very frequently used method, for example for the removal of cysts, but also diagnostically to find the cause of chronic abdominal pain, for example. Another disadvantage of laparoscopy is that it must be performed under general anesthesia, which increases the risk of surgery, such as with local anesthesia. In addition, in very overweight patients, complications can increase and laparoscopy may even be impossible.

Even if the patient has previously undergone surgery in the abdominal cavity very often and therefore has many scars, it is possible that laparoscopy leads to an increased risk and therefore a cross-section is preferred. A laparoscopy must not be performed on patients with certain previous illnesses, such as a heart attack, angina pectoris, chronic lung disease (COPD) or on patients with suspected malignant disease (tumour, cancer). In general, however, the risk of a laparoscopy in healthy patients is extremely low and therefore laparoscopy has few disadvantages.