Ashley Penton, BA, MSc, Teviah Sachs, MD, Luise Pernar, MD, Donald Hess, MD, Brian Carmine, MD, Cullen Carter, MD. Boston Medical Center
Introduction: The use of laparoscopy as a diagnostic and therapeutic tool has become routine in general surgery. However, few studies have published outcomes of laparoscopic treatment of early postoperative complications after laparotomy. The aim of this study is to contribute to the existing data regarding the feasibility of a laparoscopic approach to the management of early postoperative general surgery complications.
Methods: We reviewed charts of 9 patients who were initially operated on via open approach between 2014-2019 at a single academic center. Post-operative complications that occurred within 30 days of initial operation were managed laparoscopically. Primary outcomes (resolution by laparoscopic approach, conversion to open) and secondary outcomes (mortality, prolonged ileus, further intervention, length of stay following re-operation, discharge location) were evaluated.
Results: Eight patients were treated laparoscopically without conversion to open for their early postoperative complication. Of these patients, 7 (88%) recovered without further intervention, 3 (38%) had prolonged ileus, and 1 (13%) required a third surgery (exploratoy-laparotomy). Length of stay for these patients ranged between 3 to 22 days with median length 9 days. 5 patients (63%) were discharged to home, 2 patients (25%) were discharged with VNA services, and 1 patient (13%) was discharged to subacute rehab. The one patient requiring conversion to open experienced prolonged ileus and required an ERCP. Length of stay was 32 days. They were discharged to a long-term care facility. There were no mortalities. Length to second procedure ranged between 3 to 15 days.
Conclusion: Laparoscopic management in early complications of laparotomy is feasible in carefully selected patients and may limit morbidity.
| Complication | LaparoscopicProcedure | Conversion | |
| Subtotal colectomy with end-ileostomy | Peritonitis | Evacuated hematoma; drained abscess | |
| Radical cystectomy | SBO | Hernia Repair | |
| Abdominal mass removal | Hematoma | Washout/evacuation | |
| Pancreatic mass biopsy, feeding tube placement | Fluid Collection | Washout of clot/ascites | |
|
Cholecystectomy, right hepatectomy |
Hematoma | Washout/evacuation | |
|
Total gastrectomy, roux-en-y esophagojejunostomy |
Sepsis | Washout &drain placed | |
| Right hepatectomy | Bile leak | Washout &drain placed | |
|
Subtotal gastrectomy, roux-en-y gastrojejunostomy |
SBO | Takedown of jejunostomy, bowel resection | |
| Total abdominal colectomy | Peritonitis | Lysis of adhesions; washout;drain placed |
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This abstract was accepted for Poster presentation at the 2020 SAGES Virtual Meeting in the Miscellaneous / Other topic. Its program number was: P479 and its Abstract ID was: 101891