Premium
Novel approach to intraoperative peritoneal lavage with an extracorporeal stirring method in laparoscopic surgery for generalized peritonitis: Preliminary results
Author(s) -
Yasui Kohei,
Ishiguro Seiji,
Komatsu Shunichiro,
Matsumura Tatsuki,
Komaya Kenichi,
Saito Takuya,
Arikawa Takashi,
Kaneko Kenitiro,
Sano Tsuyoshi
Publication year - 2020
Publication title -
asian journal of endoscopic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.372
H-Index - 18
eISSN - 1758-5910
pISSN - 1758-5902
DOI - 10.1111/ases.12685
Subject(s) - medicine , laparoscopy , surgery , peritonitis , anesthesia , ileus , abdomen , retractor , saline , abdominal cavity
The primary concern with laparoscopic intraoperative peritoneal lavage (IOPL) for generalized peritonitis relates to the difficulty and uncertainty in ensuring adequate washout of contaminated fluid. Here, we describe a new method of laparoscopy‐assisted IOPL. Methods We performed emergency surgery in 10 patients with generalized peritonitis necessitating IOPL. A small wound retractor was inserted into the abdominal cavity through an incision and elevated to raise the abdominal wall. More than 3‐L saline was injected via the retractor at one time. The abdomen was manually shaken by pressure from outside the body. Contaminated fluid was removed with a long suction device through the retractor. This procedure was repeated until the fluid was confirmed to be transparent by laparoscopy, and then drains were placed. Results Median lavage time was 23.5 minutes (range, 15‐34 minutes), and volume of lavage fluid was 19 L (range, 10‐20 L). Median time to resumption of fluid intake was 3 days (range, 1‐12 days), time to food intake was 6 days (range, 3‐14 days), and time to first bowel movement was 5 days (range, 3‐10 days). Median duration of antibiotic use was 8.5 days (range, 5‐15 days). Complications were one case of antibiotic‐induced rash, two cases of paralytic ileus, and one case of pelvic abscess. All patients recovered well without additional surgical intervention. Conclusions This new approach to laparoscopy‐assisted IOPL was feasible for these patients with generalized peritonitis. This procedure enabled corpus lavage to be performed in a similarly short time to open surgery but with less invasiveness. Further research is needed to confirm indications and long‐term outcomes.