2005 SAGES Abstracts

POSTER ABSTRACTS
perforated.
Results: A total of 302 patients underwent appendectomy during
the study time. 203 patients were studied. LA was performed
in 77 patients, 115 underwent OA, and 11 patients
were converted. Complications in LA included abscess(3), Ileus
(3), and wound infection (2). OA complications include wound
infection (12), ileus (11), Abscess (7), enterocutaneous fistula
(1), cardiac (1), and hernia (1). Wound infection differences
were statistically significant.
Conclusion: LA does not appear to increase the incidence of
intra abdominal abscess formation. Furthermore, overall complications
seem to be less with LA than those seen in OA.
Prospective studies of OA vs. LA are necessary to validate
these findings.
P234–Complications of Surgery
CASE REPROT OF DELAYED SMALL BOWEL OBSTRUCTION
FOLLOWING LAPARASCOPIC-ASSISTED HEMICOLECTOMY,
David J Swierzewski MD, Robert J Hyde MS,Christian Galvez-
Padilla MD,Robert D Fanelli MD,Eugene L Curletti MD,
Berkshire Medical Surgery, Department of Surgery; University
of Massachusetts Medical School
This is a case report of Richter?s hernia through 5-mm port
after laparoscopic-assisted hemicolectomy.
The patient is an 84-year-old woman with PMHx of HTN, CHF,
Type 2 DM and COPD (on prednisone 5mg TID) who initially
underwent screening colonoscopy and had multiple polyps
removed. The patient underwent laparoscopic-assisted right
hemicolectomy to remove a sessile polyp in the cecum. Three
5-mm incisions were made in the umbilicus, suprapubic region
and the left lower quadrant using bladed trocars. A fourth incision
was made in the right lower quadrant through which the
right colon and ileum were delivered and resected. At the end
of the case, the three 5-mm incisions were closed with 4-0
Vicryl suture in a subcuticular fashion. The right lower quadrant
incision was closed with #1 PDS sutures in two layers for
the anterior and posterior sheath, and staples for the skin.
Postoperatively, the patient did not have any flatus or bowel
movement. On POD #7, the patient became nauseous and
vomited. A nasogastric tube was inserted for decompression.
By POD #10, the patient remained without bowel function. It
was decided to bring the patient back to the OR for exploratory
laparotomy. The decision not to attempt a laparoscopic
exploration was based on the amount of small bowel distention
and concern regarding safe peritoneal access. After
abdominal access was achieved through an infraumbilical
midline incision, collapsed loops of small bowel were visualized.
In addition, the entire jejunum was distended. At approximately
the midpoint of the jejunum, a portion of the antimesenteric
border was herniated through a defect in the
abdominal wall. This defect was identified and correlated with
the left lower quadrant skin incision at the 5-mm port site. The
fascial defect was closed with a running simple stitch using 2-0
Prolene.
Richter?s hernia is an infrequently encountered hernia that
involves incomplete protrusion of bowel wall through a defect.
Standard practice is to routinely close the fascia of port sites
>10 mm in adults, and >5 mm in children, to prevent such herniation.
Our case of a hernia through a 5-mm port site in an 84
year-old patient is further evidence that other factors such as
patient age, past medical history, pharmacotherapeutics (i.e.
steroids) and other factors should be considered when deciding
whether or not to close port sites < 10 mm. Additionally,
the use of non-bladed trocars may be of benefit in this subset
of patients.
P235–Complications of Surgery
LAPAROSCOPIC SPLENECTOMY FOR THE TREATMENT OF
SPLENIC AND HEMATOLOGIC DISORDERS. -A RISK OF
ENLARGED OR MASSIVE SPLENOMEGALY-, M Yasui MD, M
Sekimoto PhD,M Ikeda PhD,S Takiguchi MD,I Takemasa PhD,H
Yamamoto PhD,T Hata MD,T Shingai MD,M Ikenaga PhD,M
Ohue PhD,M Monden PhD, Department of surgery and clinical
oncology, Graduated school of medicine, Osaka University
Laparoscopic splenectomy (LS) is the surgical approach of
choice for patients with disorders requiring splenectomy. We
performed LS with patients who have normal to enlarged
spleens for the treatment of splenic and hematologic disorders.
This study was performed to evaluate a risk of splenomegaly
for perioperative complications (hemorrhage, operative time,
and more) of LS.
86 consecutive patients who admitted our hospital from 1995
to May/2004 underwent LS(or hand-assisted laparoscopic
splenectomy, HALS) for various indications. We reviewed the
perioperative outcomes and various clinical factor in the
patients. Patients were divided into three groups-normal
spleen group (splenic weight