Asian journal of endoscopic surgery · 2019
Novel approach to intraoperative peritoneal lavage with an extracorporeal stirring method in laparoscopic surgery for generalized peritonitis: Preliminary results.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Yasui Kohei, Ishiguro Seiji, Komatsu Shunichiro, Matsumura Tatsuki, Komaya Kenichi, Saito Takuya, Arikawa Takashi, Kaneko Kenitiro, Sano Tsuyoshi
Аннотация
INTRODUCTION: The primary concern with laparoscopic intraoperative peritoneal lavage (IOPL) for generalized peritonitis relates to the difficulty and uncertainty in ensuring adequate washout of contaminated fluid. Here, we describe a new method of laparoscopy-assisted IOPL.
METHODS: We performed emergency surgery in 10 patients with generalized peritonitis necessitating IOPL. A small wound retractor was inserted into the abdominal cavity through an incision and elevated to raise the abdominal wall. More than 3-L saline was injected via the retractor at one time. The abdomen was manually shaken by pressure from outside the body. Contaminated fluid was removed with a long suction device through the retractor. This procedure was repeated until the fluid was confirmed to be transparent by laparoscopy, and then drains were placed.
RESULTS: Median lavage time was 23.5 minutes (range, 15-34 minutes), and volume of lavage fluid was 19 L (range, 10-20 L). Median time to resumption of fluid intake was 3 days (range, 1-12 days), time to food intake was 6 days (range, 3-14 days), and time to first bowel movement was 5 days (range, 3-10 days). Median duration of antibiotic use was 8.5 days (range, 5-15 days). Complications were one case of antibiotic-induced rash, two cases of paralytic ileus, and one case of pelvic abscess. All patients recovered well without additional surgical intervention.
CONCLUSIONS: This new approach to laparoscopy-assisted IOPL was feasible for these patients with generalized peritonitis. This procedure enabled corpus lavage to be performed in a similarly short time to open surgery but with less invasiveness. Further research is needed to confirm indications and long-term outcomes.
METHODS: We performed emergency surgery in 10 patients with generalized peritonitis necessitating IOPL. A small wound retractor was inserted into the abdominal cavity through an incision and elevated to raise the abdominal wall. More than 3-L saline was injected via the retractor at one time. The abdomen was manually shaken by pressure from outside the body. Contaminated fluid was removed with a long suction device through the retractor. This procedure was repeated until the fluid was confirmed to be transparent by laparoscopy, and then drains were placed.
RESULTS: Median lavage time was 23.5 minutes (range, 15-34 minutes), and volume of lavage fluid was 19 L (range, 10-20 L). Median time to resumption of fluid intake was 3 days (range, 1-12 days), time to food intake was 6 days (range, 3-14 days), and time to first bowel movement was 5 days (range, 3-10 days). Median duration of antibiotic use was 8.5 days (range, 5-15 days). Complications were one case of antibiotic-induced rash, two cases of paralytic ileus, and one case of pelvic abscess. All patients recovered well without additional surgical intervention.
CONCLUSIONS: This new approach to laparoscopy-assisted IOPL was feasible for these patients with generalized peritonitis. This procedure enabled corpus lavage to be performed in a similarly short time to open surgery but with less invasiveness. Further research is needed to confirm indications and long-term outcomes.