Laparoscopic Treatment of Early Postoperative Ileus After Laparotomy.

Aim. The case report demonstrates a successful laparoscopic treatment of early postoperative small bowel obstruction after open strangulated umbilical hernia repair with mesh.Case report. An 86-year-old female was admitted to the hospital due to abdominal pain for 2 days localised in the umbilical region. A diagnosis of strangulated umbilical hernia was set, and emergency operative therapy was performed. On the third postoperative day the patient showed symptoms of bowel obstruction, confirmed on CT. An emergency laparoscopy proceeded. It revealed small intestine loop fixation to the mesh through the peritoneal defect. While separating the intestine a defect in bowel wall was found and sutured laparoscopically. Patient was discharged from the hospital on the 8th postoperative day.Conclusion. Laparoscopic treatment after open hernia surgery is an alternative access for redo surgery in early postoperative period. It provides acceptable results even in contaminated area without needs to reopen surgical wound.

SP3.2.18 Reducing the negative appendicectomy rate in children as part of the ‘improving emergency surgery’ quality improvement programme: an assessment of outcomes and balancing measures for unintended consequences

Aim To describe methodology of the quality improvement programme. To assess outcomes and balancing measures. Methods This paper describes how Kotter’s 8-step improvement model was applied in a District General Hospital. The primary outcome (negative appendicectomy rate) was assessed using GIRFT data over 6 years. Reducing negative appendicectomies might conceivably result in delayed surgery (with a potentially increased incidence of perforated/gangrenous appendicitis), increased length of stay (LOS) and increased readmissions due to delay-related complications. These were assessed by a retrospective audit of appendicectomies performed over the same 8-week period in 2016 and 2019. Results The negative appendicectomy rate in children fell from 16% in 2016-2017 (England average 12%) to 4% in 2017-2018. The improvement was sustained at 6% in 2018-2019 (England average 11%). The incidence of perforated/gangrenous appendicitis decreased by 6% from 23% in 2016 to 16% in 2019. Average LOS decreased from 4 days in 2016 to 3 days in 2019. There was 1 (3%) readmission within 7 days in 2016, and 2 (6%) in 2019. Reasons for readmission were postoperative small bowel obstruction due to omental band adhesion(1) and persistent pain (2). None were caused by delayed operation. Conclusions A sustained improvement in negative appendicectomy rate can be achieved by adopting a systematic quality improvement approach. Against expectations, the reduction in negative appendicectomy rate was associated with a slight decrease in average LOS and reduced frequency of perforated/gangrenous appendicitis. There was no significant increase in readmissions, and none were due to delayed operations.

Preperitoneal herniation as a complication of tansabdominal preperitoneal patch plasty: a report of two cases

Background Preperitoneal herniation is a rare complication after transabdominal preperitoneal patch plasty (TAPP) and may be caused by inadequate peritoneal closure. We herein report two cases of postoperative small bowel obstruction due to preperitoneal herniation through a disrupted peritoneum. Case presentation Two men in their 70s were admitted to our center because of small bowel obstruction after TAPP. After examinations and unsuccessful conservative treatment, emergency laparoscopic exploration was performed. Preperitoneal herniation through the disrupted peritoneum was found. The herniated small bowel was reduced and the peritoneum was properly reclosed. The patients recovered and were discharged with normal bowel function. Conclusions Inadequate peritoneal closure may cause preperitoneal herniation and lead to postoperative small bowel obstruction and even death. Hernia surgeons can avoid this complication by improving their suture technique and paying attention to the procedure details.

Large Lactobezoars Causing Postoperative Small Bowel Obstruction in a Neonate- A Case Report and Review of Literature

Lactobezoars causing small bowel obstruction in the postoperative period has been rarely reported. Here, a term baby with severe intrauterine growth restriction was admitted in neonatal unit for low birth weight care. Baby was started on mother’s milk and gradually upgraded to full feeds. He developed Necrotising Enterocolitis (NEC) requiring surgery. Subsequently, amino acid based formula was warranted because of Short Bowel Syndrome (SBS). After reaching full feeds, baby demonstrated signs of small bowel obstruction requiring relook laparotomy. Large lactobezoars were found throughout the small bowel which were kneaded out. Postoperative period was also complicated by Enterocutaneous Fistula (ECF) which was conservatively managed. Child was discharged on full feeds after he showed consistent weight gain.

Postoperative small bowel obstruction secondary to single malformed staple following laparoscopic total abdominal colectomy

Surgical staplers are ubiquitous in gastrointestinal surgery, especially laparoscopy. Intraperitoneal staples are designed to be inert and are generally regarded as benign; however, complications from primarily malformed staples can rarely occur. Here, we present a case of early mechanical postoperative small bowel obstruction due to a surgical staple following laparoscopic total abdominal colectomy and end ileostomy creation performed for medically refractory ulcerative colitis. Management consisted of diagnostic laparoscopy and careful extraction of a malformed surgical staple tethering a loop of small bowel to the rectal stump. Eight similar cases following gastrointestinal surgery have been identified in the literature, all occurring in the first 2 weeks following laparoscopic appendectomy. To our knowledge, this is the first case described following laparoscopic total abdominal colectomy, with high-grade small bowel obstruction at the level of the rectal stump staple line.