Laparoscopic Drainage for Fecal Peritonitis Following Anastomotic Leak. Report of a Case

H Matsuoka, MD, T Mori, MD, T Masaki, MD, T Kobayashi, MD, H Aoki, MD, Y Hashimoto, MD, T Tokutsu, MD, M Sugiyama, MD. Department of Surgery, Kyorin University, Tokyo, Japan.

In laparoscopic colorectal surgery, postoperative anastomotic leak is the critical complication and subsequent stoma creation and drainage should be performed. Even in such situation, mid-line opened abdominal drainage would be preferable approach in general. These matters lead to severe disadvantage for patients such as wound infection and less cosmesis. Laparoscopic re-operation would be preferable from the view point of potential benefit including cosmetic aspects, only if intra-abdominal irrigation and drainage are to be performed securely. However, manual irrigation such as 10 liters and generally used laparoscopic water irrigator are not ideal for high volume water irrigation during laparoscopic surgery, especially for fecal peritonitis.
A six-eight year-old patient with rectal cancer who had stoma fashioning and laparoscopic intra-abdominal irrigation for fecal peritonitis due to anastomotic leak following lap-anterior resection was treated with high volume irrigator (Strike flow two suction irrigator, Stryker Endoscopy®, USA). The irrigator provided 3liters/min. high volume water flow. In laparoscopic re-operation, intra-abdominal irrigation and drainage were securely performed by 10 liters normal saline within 15 minutes. Without creating any additional port from original port sites, whole procedure was performed. Also drainage tubes were placed through these original port sites. Following drainage tubes placement, loop transverse colostomy was fashioned. Postoperative course of laparoscopic drainage was uneventful. Six months later, stoma closure was also uneventfully performed.
Laparoscopic fecal peritoneal irrigation was possible by the high volume irrigator. Even though stoma was fashioned, additional scar was not created.