Seiichiro Yamamoto, Toshio Kanai, Kikuo Yo, Tomotaka Akatsu, Kiminori Takano, Taku Fujii, Mai Tsutsui, Yosuke Kobayashi, Yasushi Kaneko, Ryo Kaneko. Hiratsuka City Hospital
Introduction: Open colonic resection and stoma (CRS) without colonic anastomosis has traditionally and widely been used to treat patient with fecal peritonitis resulting from colon perforation. Recently, feasibility of the resection of the perforated colon with primary anastomosis (PA) in selected patients has been reported. In our institution, low risk patients with stable general condition were treated with open PA with intraoperative colonic lavage, and patients with unstable general condition or generalized peritonitis were treated with open CRS, and relatively high risk patients with stable general condition were treated with laparoscopic CRS since. The aim of the present study was to evaluate the surgical outcomes of laparoscopic CRS for selected patients with colon perforation.
Patients and Methods: Between January 2014 and July 2016, twenty-four patients with colonic perforation were treated in our institution. Of those, six patients underwent laparoscopic CRS, and the surgical outcomes are reviewed.
Results: All procedures were completed laparoscopically, and there was no perioperative mortality. There were 2 male and 4 female patients, with a median age of 76 (range: 53-84). The median duration of the operation was 202 min (range: 125-247 min) and the median estimated blood loss during surgery was 23 ml (range: 10-150 ml); no patients required intraoperative transfusion. Reasons for colonic perforation are diverticulitis in three, stercoral perforation in two, and rectal cancer perforation in one. The location of the perforation was rectum in three, sigmoid colon in two, and transverse colon in one. Irrigation of the whole abdominal cavity was performed with more than 10 L of saline laparoscopically, and three or four drainage tubes were inserted via the port site. No patient developed postoperative abdominal abscess or wound infection. However, median postoperative hospital stay was 16 days (12-25 days), and the longer hospital stay may be due to social factors such as differences in medical fees, medical insurance, and medical systems in Japan.
Conclusion: Laparoscopic CRS is a feasible and safe procedure for selected patients with colonic perforation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80005
Program Number: P065
Presentation Session: Poster (Non CME)
Presentation Type: Poster
