Mohammad Masud Karim, MBBS, Gold Medalist, FCPS, Surgery, FRCS(Glasgow, UK)1, Moshammat Zebunnesa, MBBS, FCPS, MS2, Satyajit Dhar, MBBS, FCPS, MD2, Mamun Mustafa, MBBS2. 1Noakhali Abdul Malek Ukil Medical College,Bangladesh, 2Chittagong Medical College, Chittagong.
Background: After first laparoscopic cholecystectomy by Phillip Mauret in 1987 there has been rapid explosion in the field of minimal access surgery (MAS). With increasing use of laparoscopy for various surgical procedure, the occurrence of port site tuberculosis is seen more often a postoperative complication. Most of the cases present as non-healing port site wounds. The infection has been attributed to improper sterilization of laparoscopy instruments. There is concern about the effectiveness of the sterilizing reusable laparoscopic instruments by immersion in 2% gluteraldehyde (GTA). This article describes the various features of biopsy proven port site tuberculosis. However lack of awareness of this entity leads to prolonged morbidity and may need repeat surgical interventions. In case of non-healing sinus following laparoscopic surgery keeping this possibility in mind will lead to early diagnosis and treatment.
Objective: To see the occurrence of port site tuberculosis after laparoscopic surgeries.
Materials and methods: This is a retrospective, cross-sectional, observational study carried out in one of the private hospital in Chittagong during the period of October 2005 to March 2016. Study populations were all the patients underwent various laparoscopic procedures by our team during this period. It includes laparoscopic cholecystectomy, laparoscopic appendicectomy, diagnostic laparoscopy and laparoscopic ovarian cystectomies. Surgeries were performed Storz standard laparoscopy set. Port and hand instruments were reusable one made by same brand and all were immersed in 2% GTA for 15-20 minutes before each use. 2% GTA has been changed after each 12 to 15 case intervals. More than one operation has been performed in the same afternoon in most occasions.
Results: Among all the patients of laparoscopic surgeries (3720), seventeen cases were diagnosed as port site tuberculosis which is about .45%. Fifteen of them were female ( 88.23%). Most of them were within 30-40 years of age groups. None of them had known tuberculosis prior to surgery. All were presented with non-healing port site discharge/sinus except one which was presented as abscess. All cases confirmed by biopsy. All the patients responded to four drugs anti-tubercular therapy for one year. Nine cases developed umbilical port incisional hernia later (52.94%).
Conclusion: Port site tuberculosis is not so common but troublesome for the patients and surgeons. It’s a burden to our health economy. Proper sterilization of instruments is the key. Use of 2% GTA is not cent percent effective against tuberculosis.
Key words: Laparoscopy, Tuberculosis, Port site, Sterilization.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92243
Program Number: P649
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster