Postoperative peritonis caused by thermal injury during laparoscopic colectomy: lesson learned

This video demonstrates two cases of postoperative peritonitis following laparoscopic colectomy due to bowel perforation caused by unrecognised thermal injury during the original colectomy. The first case is a colonic perforation treated with primary closure and loop colostomy and the second is a small bowel perforation repaired primarily.

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Postoperative peritonis caused by thermal injury during laparoscopic colectomy: lesson learned

Authors

F Rubino, J Leroy, A Forgione, M Simone, J Marescaux

Abstract

This video demonstrates two cases of postoperative peritonitis following laparoscopic colectomy due to bowel perforation caused by unrecognised thermal injury during the original colectomy. The first case is a colonic perforation treated with primary closure and loop colostomy and the second is a small bowel perforation repaired primarily.

Classification

complex cases

Keywords

thermal bowel injury, complication, laparoscopic colectomy

Media type

Surgical video

Duration

07'00''

Publication

2006-10

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E-publication

WeBSurg.com, Oct 2006;6(10).
URL: http://www.websurg.com/doi-vd01en2023.htm

Postoperative peritonis caused by thermal injury during laparoscopic colectomy: lesson learned

1. Description of the injury and treatment 00'12''

Postoperative peritonitis due to leak of bowel perforation after laparoscopic colectomy often requires re-operation by conventional open surgery. We show 2 cases of laparoscopic re-intervention for the treatment of postoperative peritonitis due to bowel perforation in previous colectomy. The 1st case is postoperative peritonitis as shown here after laparoscopic left colectomy. A bowel injury is clearly seen by re-intervention. Inspection of the bowel loops allow to identify this 1cm hole in the descending colon. The injury is closed with a separate stitch of non-absorbable material. A large lavage of the cavity is performed. A transverse colostomy is performed to protect the suture site in the descending lesion.

2. The mechanism of the perforation of the 1st case 01'33''

Review of the initial operation allows to identify the mechanism of perforation in an inappropriate use of the Atlas Ligasure sealing device. This instrument is used to open the omentum, and as you can clearly see here the bowel is exposed. The surgeon continues the dissection near to the place where the lesion was done. No lesion was seen at that moment but perforation happened in the next postoperative hours.

3. 2nd case: description of the injury and treatment 02'29''

The 2nd of the 2 cases is a postoperative peritonitis after laparoscopic right colectomy. The patient was re-operated on postoperative day 2 and under laparoscopic approach. This injury of small bowel was easily recognized and the stitches were put in order to fix this bowel and hold the anastomosis. Entero-entero anastomosis was performed. A large anastomosis is achieved with the use of laparoscopic stapler. The site of perforation is then resected also with the endoscopic stapler. These 2 cases show the feasibility of laparoscopic treatment for postoperative peritonitis when re-intervention is readily performed. This video emphasizes the risk of using energy-driven instruments as dissecting tools. Review of the initial operation again allows to identify the mechanism of perforation in an inappropriate use of the Atlas Ligasure sealing device.

4. The mechanism of the injury of the 2nd case 04'28''

Clearly shown by the arrow. Careful review of the initial operation allows to recognize the mechanism of perforation, which in both cases depended on the inappropriate use of dissecting coagulating instruments.