2005 SAGES Abstracts

POSTER ABSTRACTS
Results: 7 perforations occurred proximal to the recto-sigmoid
junction and 5 were identified distal to the descending colonsigmoid
junction. One patient (on high doses of steroids)
demonstrated a proximal ascending colon perforation with
localized fecal peritonitis. Lacerations ranged in size from an
approximately 1 cm lesion to a near- circumferential transection.
The latter was treated with segmental resection followed
by primary anastomosis. The remaining twelve perforations
were managed utilizing lateral sutures. Extensive peritoneal
lavage was performed, and broad-spectrum antibiotics were
administered. There was a 0% incidence of anastamotic leaks,
intraperitoneal abscesses, or trocar site infections.
Conclusions: One stage laparoscopic management of early
iatrogenic colonic perforations is a safe, effective, and minimally
invasive method of treatment. The procedure was
notably met with a high level of patient satisfaction. From our
series, we have encountered 0% mortality and negligible morbidity
employing laparoscopic management. Further study
comparing subjects undergoing laparatomy versus
laparoscopy following IP is certainly warranted. At this stage,
we recommend laparoscopy as a potentially superior management
strategy for patients, particularly for those with comorbidities
that limit operability.
P352–Minimally Invasive Other
LAPAROSCOPIC BIOPSY OF PARA-AORTIC LYMPHNODE-COM-
PARISON BETWEEN TRANSPERITONEAL APPROACH AND
EXTRAPERITONEAL APPROACH, Takashi Iwata MD, Nobuhiro
Kurita MD,Masaki Nishioka MD,Tetsuya Ikemoto MD,Mitsuo
Shimada PhD, Department of Digestive Surgery, School of
Medicine, Tokushima University.
INTRODUCTION: Improvements in instrumentation and video
technology have allowed the surgeon to perform more complex
and major operations through the laparoscope. The technique
of laparoscopic para-aortic lymphadenectomy is usually
performed via a transperitoneal approach (TP). In the gastrointestinal
surgery, adhesions and complications using a
extraperitoneal approach (EP) have been scarcely reported to
be fewer than those in a TP. We experienced cases of laparoscopic
lymph node biopsy, and evaluated effect of TP versus
EP regardly the intraoperative blood loss, operation time and
postoperative complications.
METHODS: A transperitoneal laparoscopic lymph-node biopsy
was attempted with 3 ports on one patient of esophageal cancer
(Mt,T2) with massive abdominal lymphadenopathy. Biopsy
of the para-aortic lymph-nodes was difficult in the TP, therefore
1.5cm sized lymph node along the common hepatic artery
was biopsied. On the other hand, the EP lymph-node biopsy,
5cm sized para-aortic lymph-node, was successfully performed
with 4 ports on the other patient with malignant lymphoma.
RESULTS: Intraoperative blood loss was 270ml v.s. 100ml (TP
v.s. EP, respectively) and operation time was 150 minutes v.s.
143 minutes. After operation oozing from lymphadenectomy
continued for 5 days in TP case, EP case could walk 1st operative
date.
CONCLUSIONS: The extraperitoneal laparoscopic biopsy of
para-aortic lymph-nodes is useful method for para-aortic lymphadenectomy
compared with transperitoneal approach.
P353–Minimally Invasive Other
CAN INTRAOPERATIVE LAPAROSCOPIC ULTRASOUND
REPLACE INTRAOPERATIVE CHOLANGIOGRAPHY DURING
LAPAROSCOPIC CHOLECYSTECTOMY?, Teresa L LaMasters
MD, Nicole M Fearing MD,R Stephen Smith MD,Jonathan M
Dort MD, University of Kansas School of Medicine - Wichita,
and Via Christi Regional Medical Center - St. Francis Campus
Background: Controversy surrounding the proper evaluation of
the common bile duct during laparoscopic cholecystectomy
has existed for several years. Recently, intraoperative laparoscopic
ultrasound (ILUS) has been proposed as a safe alternative
to intraoperative cholangiography (IOC). We hypothesized
ILUS is a faster alternative to IOC with increased ability to
determine anatomy.
Objectives: (1) To evaluate the ability of ILUS to evaluate biliary
anatomy compared to IOC. (2) To evaluate the amount of
time necessary to perform ILUS compared to IOC.
Methods: The use of ILUS vs. IOC in a university-affiliated tertiary-care
center was prospectively evaluated. Seventy-five
patients were included in the study. Each patient underwent
ILUS followed by IOC. The ability to define biliary anatomy
and the time required to complete each procedure was recorded.
Results: ILUS was performed more expeditiously than IOC (5.7
min vs. 11.2 min, p