ASSESSMENT OF LAPAROSCOPIC MANAGEMENT OF INTESTINAL PERFORATION

Background: Intestinal perforation is a surgical emergency often, encountered. Usually, coelotomy is performed to manage intestinal perforation. It has been the gold standard approach to deal with intestinal perforation for the past decades in conjunction with various procedures. Post laparotomy wound related complications have been the biggest challenge for general surgeons till date, so much as to adding up to morbidity, as severe as burst abdomen. Laparoscopic management of perforation is a recent technique. Aim: The present study is aimed to assess the efficacy of laparoscopic management of intestinal perforation. Material and Method: Prospective study of 75 patient admitted and operated in National Institute of Medical Sciences & Research. Intestinal perforation (traumatic and not traumatic) will be managed through laparoscopic procedure. The perforated intestine will be – Identified and exteriorized with or without repair of perforation. Adequate peritoneal toilet would be performed. Sub diaphragmatic and pelvic spaces will be drained. The outcome of the patients will be assessed in regards to- Total hospital stay, Any associated complications – local or distant. Cause of mortality. Results: In present study the perforation peritonitis was found to be in 70.6% with 58.6% ileal perforation 17.1% jejunal perforation. In our study 52% patients managed laparoscopically 33.3% laparoscopic with exteriorization and 14.6% were converted to open surgery. Various cause for open surgery includes 27.2% multiple perforation,9.2% cardiac disease and 63.6v % site not identified laparoscopically. Patients managed laparoscopically had less complications as compared to open. Conclusion: dealing with intestinal perforation or associated peritonitis using minimal access technique is feasible and in turn helpful in minimizing the most dreaded morbidity i.e. the surgical site infections which can be reduced with improving skills and thorough lavage. Other factors associated with post-operative morbidity i.e. ambulation can be started as early as post operative day one. Prolonged hospital stay can be also be reduced and patients can be sent home early decreasing risk for nosocomial Keywords: Laparoscopic, intestinal, perforation, perforation peritonitis