Which of the following is an absolute contraindication to laparoscopy?

• A. History of appendectomy
• B. Inability to tolerate laparotomy
• C. Chronic constipation
• D. Controlled hypertension

Answer: (B)

The key idea is that an absolute contraindication to laparoscopy is a condition in which the patient cannot safely undergo any surgical approach, even the least invasive one, because the stresses of surgery (anesthesia and pneumoperitoneum) cannot be tolerated.

If a patient cannot tolerate a laparotomy, they also cannot tolerate laparoscopy, since both procedures require general anesthesia and physiological changes from insufflation. In this scenario, proceeding with laparoscopy would pose an unacceptable risk to the patient, making it an absolute contraindication.

History of appendectomy, chronic constipation, and controlled hypertension do not by themselves prevent safely performing laparoscopy. They may be relevant for planning and risks, but they are not absolute barriers.