Modern minimally invasive approaches in the management of postoperative intra-abdominal complications: efficacy analysis and tactical decision-making

Modern minimally invasive techniques for the treatment of postoperative intra-abdominal complications (IACs) represent a promising direction in abdominal surgery, aimed at reducing the invasiveness of interventions and improving clinical outcomes. The study analyzes the efficacy of methods such as laparoscopy, endoscopic interventions, and percutaneous drainage techniques compared to traditional relaparotomies. Special attention is paid to tactical decisions, including access selection, insufflation control, and the use of laparo-lifting to minimize the risk of intraoperative complications. The materials and methods of the study include an analysis of 225 minimally invasive interventions in patients with IACs, such as anastomotic leaks, intra-abdominal abscesses, bile leakage, and peritonitis. The primary methodological platform was laparoscopy, supplemented by laparo-lifting techniques. Key aspects involved the safe insertion of trocars, maintaining optimal intra-abdominal pressure, and the use of alternative access points in patients who had undergone biliary tract surgery. The results showed that diagnostic laparoscopy using two trocars was sufficient for initial revision in 73% of cases. The use of minimally invasive methods reduced the frequency of intraoperative complications, particularly during adhesiolysis, where replacing electrocautery with precision dissection techniques decreased the risk of intestinal perforation. However, in 20.5% of cases, conversion to open laparotomy was required due to the inability to accurately identify the source of bile leakage amid severe inflammation. The study highlights the importance of an individualized approach to selecting intervention methods, the need to improve diagnostic techniques, and further research into the long-term outcomes of minimally invasive technologies. The findings may contribute to the development of clinical algorithms aimed at optimizing surgical care for patients with postoperative IACs.