laparoscopic duodenal perforation

LAPAROSCOPIC CLOSURE OF DUODENAL PERFORATION

A STUDY OF 70 CASES

Dr. ASHISH MOTEWAR

DEPARTMENT OF SURGERY,

GOVERNMENT MEDICAL COLLEGE,

NANDED.

AIMS AND OBJECTIVES

COMPARATIVE STUDY FOR

FEASIBILITY AND RESULTS OF

LAPAROSCOPIC CLOSURE OF

DUODENAL PERFORATION

WITH TRADITIONAL

OPEN METHOD

CASE SELECTION

JAN. 2001 to AUG. 2003

RANDOMLY SELECTED

LAP. : 70 CASES

OPEN : 70 CASES

CASE SELECTION

DURATION OF ONSET OF

PAIN AND SURGERY

RANGED FROM

6 HRS. TO 4 DAYS

PORT PLACEMENT

510

5

10

ASPIRATION OF FLUID

SUTURING OF PERFORATION

PLACING OMENTAL PATCH

BLADDER

INSERTION OF DRAIN

R E S U L T S

Pt. At 36 hrs.

PAIN :

ANALGESIC REQUIREMENT

LAP : 1 DAY

OPEN : 4-5 DAYS

R E S U L T S

MOBILISATION :

MOVED ON SECOND DAY AND

WERE OUT OF BED.

WHEREAS IN OPEN GROUP

IT WAS SEEN IN 4 - 5 DAYS With 3 Ports

R E S U L T S

RT ASPIRATE :

LESS RT ASPIRATE WAS SEEN

LAP : OPEN

250 ML : 500 ML

R E S U L T S

DISCHARGE :

LAP : 6 TH DAY

OPEN: 10 TH DAY

R E S U L T S

WOUND COMPLICATIONS :

LAPAROSCOPIC OPEN

- PORTSITE - MINOR WOUND INFECTION - 3 CASES

ABSCESS - 2 CASES - SKIN GAPE - 2 CASES

- BURST ABDOMEN - 3 CASES

- INCISIONAL HERNIA - 1 CASE

R E S U L T SSCAR :

LAPAROSCOPIC SCAR LAPAROTOMY SCAR

R E S U L T S

OPERATING TIME :

LAP : OPEN

40 MIN. : 60 MIN.

MINIMUM TIME : 20 MIN.

MAXIMUM TIME : 75 MIN.

R E S U L T S

CONVERSIONS IN LAPAROSCOPY :

3 CASES (4%) WERE CONVERTED

TO OPEN SURGERY

2 - GUT WALL FRAGILITY

1 - NON VISUALISATION OF

PERFORATION

R E S U L T S

REEXPLORATION :

LAP : 2 CASES (3%)

OPEN : 4 CASES (6%)

R E S U L T S

MORTALITY :

LAP : 1

OPEN : 3

C O N C L U S I O NLESS PAIN AND ANALGESIC REQUIRMENT

C O N C L U S I O NEARLY MOBILISATION

C O N C L U S I O NLESS RESPIRATORY COMPLICATIONS

C O N C L U S I O NEARLY DISCHARGE

C O N C L U S I O NEARLY RETURN TO WORK WITHOUT ANY HINDRANCE

C O N C L U S I O NLOW INCIDENCE OF WOUND INFECTION

C O N C L U S I O N

NO SCAR

C O N C L U S I O NLESS OPERATIVE TIME

THANK

YOU !