Identification of peritoneal reflection and treatment of peritoneal injury in retroperitoneal laparoscopic surgery
Men Qunli1, 2,Guo Gang1,Cai Wei1,Zhu Qiang1,Liu Peng3,Zhang Xu1
1Department of Urology, General Hospital of PLA , Beijing 100853, China; 2Department of Urology, Baoji Central Hospital; 3Department of Urology, the First Hspital of Yulin City
Abstract：Objective:To analyze the anatomical features of reflection in retroperitoneal laparoscopy and reasons of peritoneal rupture, and explore the prevention and treatment of intraoperative peritoneal rupture in retroperitoneal laparoscopy. Methods:Peritoneal rupture status, location and treatments in 483 patients from 2013 February to 2013 October in Chinese PLA General Hospital were retrospectively analyzed. Retroperitoneal anatomical characteristics of peritoneal rupture were studied through the literature review. Results:Fifty-three patients (37 males, and 16 females) with the age of 19-78 years old experienced intraoperative peritoneal rupture in retroperitoneal laparoscopic surgery with the incidence being 11.0%. There were 21 cases on the left side, and 32 on the right side. The peritoneal rupture was located under the diaphragm in 9 cases, in kidney ventral area in 41 cases, and in renal iliac fossa area in 3 cases. Forty cases underwent nephrectomy, 8 cases adrenalectomy, and 5 cases renal pelvis and ureter surgery. Peritoneal rupture occurred during the retroperitoneal preparation and trocar placement in 8 cases, and in 45 cases odue to improper operation. All of these cases did not experience intraoperative peritoneal lesions. After peritoneal rupture, the peritoneal around the crevasse was fully dissociated, abdominal pneumatosis was terminated, the peritoneal crevasse clipped with separating pliers after laceration occlusion, and finally the peritoneal crevasse was clipped with Hem-o-lok. For larger crevasse, the abdominal pressure was decompressed through abdominal puncture with silk, then peritoneal crevasse was clippd with Hem-o-lok or sutured. Fifty 53 cases of peritoneal rupture successfully underwent retroperitoneal laparoscopic surgery without postoperative peritoneal rupture-related complications. Conclusions:Peritoneal rupture is a common complication during retroperitoneal laparoscopic surgery. The incidence of the peritoneal rupture can be effectively reduced probably by accurately identifying the peritoneal reflection. And a variety of methods can deal with peritoneal rupture effectively.
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