Ajay Bhandarwar, MS, Amol Wagh, MS, Saurabh Gandhi, MS, Shubham Gupta, MS, Eham Arora, MS, Gagandeep Talwar. Grant Government Medical College & Sir J.J. Group of Hospitals, Mumbai, India
Objective: Small bowel perforation has conventionally been dealt with open exploration, which frequently leads to many wound-related complications. Wound infection is the major reason for increasing morbidity in these patients and delay recovery. Laparoscopic surgery has various benefits over open surgery like, smaller wound, lesser pain and faster recovery. The aim of this study was to relay the advantages of minimally invasive surgery (MIS) to patients with small bowel perforation to decrease postoperative wound complications and duration of hospital stay.
Methods: It is a retrospective study, including 136 patients with small bowel perforation from 2013 to 2016. Of these 136, 43 had traumatic etiology, 28 had typhoid-related perforation and the remaining 65 had a duodenal perforation. 84 of them were male, and the average age was 30.4 years. Only patients who presented within 96 hours of perforation were included in the study.
Laparoscopic exploration was done on introducing camera from 10-mm infraumbilical port after intraperitoneal carbon dioxide insufflation. The remaining two 5-mm working ports were then introduced depending on the site of perforation once identified. The perforations were then repaired using intracorporeal single-layer suturing using Polydioxanone 3– 0 suture. The peritoneal cavity was given thorough lavage and abdominal drain placed in the pouch of Douglas.
Fecal contamination was found in all the patients. A total of 6 patients underwent conversion to open surgery due to inability to find the site of perforation laparoscopically. Of the 136 operated patients, 7 patients developed port-site infection, and there were no major postoperative complications in the 4-week follow up period.
Conclusion: We conclude from our study that laparoscopic intervention in early small bowel perforation is a safe approach with favorable outcomes, especially with regards to wound complications, that are a major factor in increasing the morbidity in such patients postoperatively. Laparoscopic approach leads to early discharge and recovery postoperatively. With the emerging era of laparoscopic surgery, leading to its easy accessibility, more patients can advantage from this technique when they arrive in emergency with intestinal perforation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87286
Program Number: P051
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster