laparoscopic duodenal perforation
TRANSCRIPT
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 !