2274 Laparoscopic Primary Repair of Duodenal Perforation after Laparoscopic Para-Aortic Lymphadenectomy

Abstract

Video Objective To present of laparoscopic primary repair of duodenal perforation after laparoscopic paraaortic lymphadenectomy for the patient with endometrial carcinoma. Setting Case study. University hospital in Korea. Interventions A 78-year-old Korean woman with postmenopausal bleeding and thickened endometrium presented to our department. The histopathology of biopsied endometrium revealed grade 1 endometrioid adenocarcinoma. The preoperative MRI shows an about 5cm sized tumor within the endometrial cavity suspicious myometrial invasion. We perform the laparosco pic staging surgery on April 2, 2019. No intraoperative complications were recognized. However, on postoperative day 1, the color of intra-abdominal drainage change from serosanginous to dark green. We strongly suspected small bowel perforation and perform secondary laparoscopic surgery immediately. Peritoneum and prior operative site were tinged with bile. We scrutinized the small bowel and finally found the perforation site on duodenum. The perforation occurred at the horizontal part of duodenum ventrally vena cava. We carried out laparoscopic primary repair with 3-0 vicryl. Double layer closure was done by interrupted suture in first layer and Lambert suture for second layer. Then, we placed drainage into the duodenal repair site and traced the small bowel meticulously. We reviewed the video of primary surgery. But there was no definitive procedure related with duodenal perforation. We thought that the thermal injury was occurred by ultrasonic cutting and coagulating device during the lymphadenectomy in pre-caval area just below duodenum or mechanical micro-perforation is made during lifting the duodenum by dissecting forcep. After duodenal repair, endoscopically guided placement of nasogastric tube was performed. Gastrography did not show any leakage at the site of duodenal repair on postoperative day 3. Conclusion Immediate laparoscopic primary repair of duodenal perforation after laparoscopic paraaortic lymphadenectomy is safe and feasible.