Rare Complication Of Laparoscopic Surgery Research Articles

A Case of Skin Burns Occurring during Laparoscopic Surgery

Skin burn injury from light cables is a rare complication of laparoscopic surgery. We report the case of a 57-year-old female who underwent laparoscopic-assisted right hemicolectomy under general anesthesia. During surgery, the anesthesiologist discovered that the tip of the light cable, with the light source powered on, penetrated the surgical drape and was positioned on the right forearm of the patient, where a bulla measuring 2.0× 2.5 cm in size and a second-degree burn were identified. All medical personnel participating in laparoscopic and arthroscopic procedures should always be aware that the light cable can cause burns to the patient. Additionally, after connecting the light cable to the scope, the light source should be activated. The light cable should not be placed around the patient or on the surgical drape while the light source is active. Immediately after completing the surgery, the power to the light source should be turned off, and the light cable should be placed in a safe place.

Cerebral infarction by paradoxical gas embolism detected after laparoscopic partial hepatectomy with an insufflation management system: a case report

BackgroundLaparoscopic surgery has reduced surgical morbidity and postoperative duration of hospital stay. Gas embolism is commonly known as a risk factor for all laparoscopic procedures. We report a case of severe cerebral infarction presumably caused by paradoxical CO2 embolism in laparoscopic partial hepatectomy with an insufflation management system.Case presentationA male in his 60 s was diagnosed with recurrence of liver metastasis in the right hepatic lobe after laparoscopic lower anterior resection for rectal cancer. We performed laparoscopic partial hepatectomy with an AirSeal® under 10 mmHg of intra-abdominal pressure. During the surgery, the patient’s end-tidal CO2 and percutaneous oxygen saturation dropped from approximately 40–20 mmHg and 100–90%, respectively, while the heart rate increased from 60 to 120 beats/min; his blood pressure remained stable. Postoperatively, the patient developed right hemiplegia and aphasia. Brain magnetic resonance imaging showed cerebral infarction in the broad area of the left cerebral cortex. Thereafter, transesophageal echocardiography revealed a patent foramen ovale, suggesting cerebral infarction due to paradoxical gas embolism.ConclusionsA patent foramen ovale is found in approximately 15–20% of healthy individuals. While gas embolism is a rare complication of laparoscopic surgery, cerebral infarction must be considered a possible complication even if the intra-abdominal pressure is constant under 10 mmHg with an insufflation management system.

Comparative Study of the Incidence of Port Site Infection in Disposable Ports and Reprocessed Disposable Ports in Laparoscopic Cholecystectomy.

Port site infection (PSI) is a rare complication of laparoscopic surgery that can reduce the benefits of this minimally invasive surgery and increase postoperative complications. As a variety of disposable ports (single-use ports) and reprocessed ports are used in laparoscopic surgeries, this study was conducted to compare the incidence of PSI in disposable ports and reprocessed disposable ports in laparoscopic cholecystectomy (LC). In this prospective cohort study, 473 patients were studied. Two hundred fifteen and two hundred fifty eight were in the disposable port group and reprocessed disposable port group, respectively. The demographic characteristics and incidence of superficial and deep infection were evaluated using the researcher-made checklist of infection assessment standards at intervals of 3 to 5 and 5 to 14 days following LC using call and physical examination on day 14. Data analysis was performed using descriptive statistics and statistical tests in SPSS software. The incidence of PSI, 3 to 5 and 5 to 14 days after surgery in the reprocessed disposable port group was significantly higher than that in the disposable ports group. In both groups, all PSI accrued in the epigastric port area (where the gallbladder was removed) ( P < 0.05). On the basis of the results, our study suggests using disposable ports instead, and in the case of using reprocessed disposable ports in LC, upgrading of disinfection and sterilization techniques is necessary.

A rare case of 5-mm trocar-site hernias after laparoscopy rectopexy requiring surgical repair

The 5 mm trocar-site hernia are very rare complication of laparoscopic surgery and surgeons usually avoid fascial closure at 5 mm trocar-site. We show a case of laparoscopic anterior rectomeshplasty with early omental herniation through a 5 mm trocar-site and surgical repair, as well as an advice on whether or not to undertake a fascial closure of the 5 mm trocar-site.

Acute Bowel Obstruction Complicating Peritoneal Endometriosis Resection.

<h3>Study Objective</h3> Describe a rare complication of laparoscopic surgery, acute bowel obstruction, and review ways to prevent it. <h3>Design</h3> Case report. <h3>Setting</h3> Hospital. <h3>Patients or Participants</h3> Patient submitted to peritoneal endometriosis resection complicating with acute bowel obstruction due to internal hernia. <h3>Interventions</h3> Diagnosis and treatment of internal hernia after endometriosis surgery. <h3>Measurements and Main Results</h3> Steps to diagnosis and surgical treatment. <h3>Conclusion</h3> Low threshold to re-operate is needed.

Hernia incisional bilateral después de laparoscopia. Caso clínico y revisión de la literatura

El uso creciente de la laparoscopia ha resultado en complicaciones adicionales específicas para este tipo de abordaje, tales como las hernias incisionales que se asocian generalmente con el tamaño del trocar &gt; 10 milímetros. Estas representan una complicación rara de la cirugía laparoscópica, con una incidencia reportada de &lt; 1%, son causa de morbilidad postoperatoria y requieren cirugía inmediata. Todos los puertos de ingreso de los trocares deben cerrarse para evitar tales complicaciones. Se describe un caso de hernia incisional bilateral después de laparoscopia. Se trata de paciente femenina de 35 años con antecedentes de cirugía laparoscópica con abordaje de 3 puertos, quien presentó vómitos, dolor abdominal de moderada intensidad y distensión abdominal. La tomografía axial computarizada mostró asas intestinales en el sitio de colocación de los trocares en ambas fosas iliacas. Durante la laparoscopia de emergencia se encontraron asas intestinales distendidas, con dos porciones incluidas en los defectos bilaterales de la fascia del hemiabdomen inferior.

Gastropericardial fistula, uncommon complication for common surgical procedure

Gastropericardial fistula is an acquired disorder that is associated with a high mortality rate. It is a rare complication of laparoscopic surgery for reflux disease and thoracic procedures. A 74-year-old lady with history of gastroesophageal reflux disease (GERD) and surgically repaired hiatal hernia presented with history of chronic dyspnea and cough. Physical examination was normal apart of a pericardial rub. Laboratory data showed leukocytosis and the chest X-ray showed a large left-sided soft mass. As result of the mass on chest x ray, chest and abdominal CT scan was done and showed large pericardial effusion with hiatal hernia and gastro-pericardial connection. Gastropericardial fistula is an uncommon complication but it has very high mortality rate. Among causes that result in this condition, hiatal hernia and esophagogastric surgery have been the most frequently reported. The occurrence of post-operative gastropericardial fistula is induced by the perihiatal scarring. In addition, recurrence of hiatal hernia or migration of the surgical wrap may also favor occurrence of fistulae. For gastropericardial fistula, contrast media-enhanced traditional examinations are the cornerstone of diagnosis. Abdominal CT may reveal the fistula. Surgical correction is the most effective form of treatment.

Early Detection and Successful Release of Richter's Hernia in a 5-mm Laparoscopic Port Site

Abstract Background: Richter's hernias, through the laparoscopic port site, are a rare complication of laparoscopic surgery; however, the severity of the complication necessitates early recognition and intervention to prevent bowel ischemia and ultimately bowel resection and its associated morbidity and mortality. Studies have identified that port sites 10 mm and greater are associated with the highest risk of Richter's hernias and that closing these larger port sites in layers reduces this risk. Case: A case of Richter's hernia in a 5-mm port site that was successfully recognized and treated without the need for a bowel resection. Conclusion: We discuss whether preventative measures should be employed for smaller port sites, given the severity of the potential complications. (J GYNECOL SURG 31:232)

Massive subcutaneous emphysema following laparoscopic nephroureterectomy: An unusual presentation

Sir, Laparoscopic approach to surgery has expanded its horizon tremendously. It is a preferred approach in many general, urological and thoracic procedures. Massive subcutaneous emphysema is a rare complication of laparoscopic surgery. We report here such a complication after laparoscopic nephroureterectomy using carbon dioxide (CO2) as an insufflating gas. A 62 yr old male, weight 65kg, American Society of Anesthesiologists physical status II was scheduled for nephroureterectomy for sarcoma left kidney through transperitoneal approach. The only positive history revealed in preoperative evaluation was hypertension since 2 yrs. In the operating room, intravascular cannulation was established after baseline routine monitoring [electrocardiography, non-invasive blood pressure, pulse oximetric oxygen saturation (SpO2) and end-tidal CO2, (ETCO2)]. Standard general anaesthesia induction and intubation was performed using injection fentanyl, propofol and vecuronium bromide. Patient was maintained on O2:N2O (35:65) and isoflurane. Pneumoperitoneum was created using CO2 insufflation and was maintained for 4 hours. Intraoperatively, cardiovascular parameters, EtCO2 and peak inspiratory pressure remained normal throughout. The intra- abdominal pressure was in the range of 12-13 mm Hg. Maximum EtCO2 noticed during this period was 42mm Hg, which was normalised by increasing minute ventilation. 3 h after creation of pneumo-peritoneum, patient was noted to have developed marked subcutaneous emphysema over face, neck and chest. Skin crepitus was more on lateral aspects of neck bilaterally. It involved both the eyelids. Caudal extent of emphysema could not be demarcated due to patient positioning and surgical drapes. Arterial blood gas analysis (ABG) was obtained and found to be normal. All ventilatory parameters including EtCO2 were within normal limits at this moment. The surgeon was notified about emphysema. Pneumoperitoneum was deflated after nephrectomy. Uretrectomy was done after opening the abdomen. Entire surgery lasted for 6 hrs. Facial swelling and crepitus over neck started resolving gradually after deflation of pneumoperitoneum. At the end of surgery, direct laryngoscopy was done to exclude the presence of pharyngeal emphysema and laryngeal oedema which may accompany subcutaneous emphysema of face and neck and can cause airway obstruction. Arterial blood gas (ABG) values were repeated and found to be normal. The patient was extubated after confirming audible leak on positive pressure ventilation, after deflating the endotracheal tube cuff, ruling out tracheal compression by neck emphysema. Gaseous collection was allowed to be drained by spontaneous absorption and exhalation. Patient was transferred to ICU for further monitoring. Postoperative chest radiograph in intensive care unit (ICU) confirmed the diagnosis of surgical emphysema in the neck and chest and ruled out pneumothorax and pneumomediastinum. Patient remained stable in post operative period and was transferred to ward next day. Massive subcutaneous emphysema is an extremely rare complication.[1,2] On palpation, it produces an unusual crackling sensation as the gas in pushed through the tissues. Severity of emphysema can be compared on a four point scale.[3] (0) No subcutaneous emphysema, (1) Mild emphysema with crepitus at trocar insertion site, (2) Mild emphysema with crepitus extending to the abdomen and thighs. (3) Massive emphysema extending to the chest, neck and face. Prolonged surgery and pneumoperitoneum of >200 minutes, insufflation of CO2 at pressure ≥15 mm Hg, 6 or more ports and old age due to decrease in natural subcutaneous resistance are the factors which predispose to the risk of development of subcutaneous emphysema.[4,5] The patient had massive subcutaneous emphysema probably due to prolonged pneumoperitoneum of 4 hours duration. Age of the patient was another possible factor which may be responsible for such massive emphysema. Absence of rise in EtCO2 was unusual, a finding contrary to most reports where an increase in EtCO2 was found along with massive subcutaneous emphysema. Our findings are consistent with the finding of Giorgakis and Fernandez-Diaz where they found no increase in EtCO2 intraoperatively.[6] In view of the paucity of literature showing massive subcutaneous emphysema in the absence of increased EtCO2, we wished to share our experience. We recommend that the patient should be closely examined under the drapes intraoperatively even if ventilatory parameters are normal on monitor.

English

INTRODUCTION: Less than 10 mm port-site herniation is a rare complication after laparoscopic surgery. We report a case of complicated herniation through the 5-mm suprapubic trocar port site. CASE REPORT: A 58-year old obese male was admitted due to intestinal obstruction. He has undergone the laparoscopic appendicectomy 1 year ago. On examination, abdomen was bloated and roughly 10 cm size mass was palpable on the suprapubic area. Plane radiogram of the abdomen showed signs of intestinal obstruction. Since conservative treatment was ineffective, the patient was operated on. The laparotomy revealed a protrusion of a part of right large intestine and greater omentum into the subcutaneous space through the abdominal wall defect. There was a dilatation of intestines proximally incarcerated colon. It was released and a part of omentum was resected. The peritoneum and fascia-muscular defect was closed by interrupted vicryl sutures. CONCLUSION: Acute herniation through a 5 mm size most lateral trocar port site is a rare complication of laparoscopic surgery requiring prompt differential diagnosis.

Postoperative Ascites of Unknown Origin following Laparoscopic Appendicectomy: An Unusual Complication of Laparoscopic Surgery.

Postoperative ascites is a very rare complication of laparoscopic surgery. Significant iatrogenic injuries to the bowel, the urinary tract, and the lymphatic system should be excluded promptly to avoid devastating results for the patient. In some cases, in spite of investigating patients extensively, no definitive causative factor for the accumulation of fluid can be identified. In such cases, idiopathic allergic or inflammatory reaction of the peritoneum may be responsible for the development of ascites. We present a case of ascites of an unknown origin in a young female patient following a laparoscopic appendicectomy.

Intestinal ischemia following laparoscopic surgery: a case series

IntroductionIntestinal ischemia is a rare complication of laparoscopic surgery. Its prognosis depends on a high index of suspicion and effective early treatment.Case presentationIn the present report, we describe three cases where intestinal ischemia developed following laparoscopic surgery. Case 1 concerns a 52-year-old Caucasian man who developed large bowel ischemia following laparoscopic adjustable gastric band surgery. Case 2 concerns an 82-year-old Caucasian woman who developed fatal intestinal ischemia following laparoscopic cholecystectomy. Case 3 concerns a 58-year old Caucasian woman who developed right-sided lower intestinal ischemia following open cholecystectomy.ConclusionsIntestinal ischemia is a rare complication of laparoscopic surgery. The identification of high-risk patients is an essential primary preventive measure. A high index of suspicion is required to make an early diagnosis, which may help improve outcomes.

A case report of incisional hernia through a 5 mm lateral port site following laparoscopic cholecystectomy

INTRODUCTION:Less than 10 mm port-site herniation is a rare complication after laparoscopic surgery. We report a case of complicated herniation through the 5-mm lateral trocar port site.CASE REPORT:A 63-year old obese female was admitted due to intestinal obstruction. She has undergone the laparoscopic cholecystectomy 1 year ago. On examination, abdomen was bloated and roughly 10 cm size mass was palpable on the right subcostal area. Plane radiogram of the abdomen showed signs of intestinal obstruction. Since conservative treatment was ineffective, the patient was operated on. The laparotomy revealed a protrusion of a part of right large intestine and greater omentum into the subcutaneous space through the abdominal wall defect below right subcostal margin. There was a dilatation of intestines proximally incarcerated colon. It was released and a part of omentum was resected. The peritoneum and fascia-muscular defect was closed by interrupted vicryl sutures.CONCLUSION:Acute herniation through a 5 mm size most lateral trocar port site is a rare complication of laparoscopic surgery requiring prompt differential diagnosis.

A rare complication of laparoscopic surgery

Gallstone disease is one of the most common problems affecting the digestive tract. Symptomatic patients are advised to undergo laparoscopic cholecystectomy (LC), which is considered the gold standard of care in these patients. LC has clear advantages over traditional surgery such as a shorter hospital stay, an earlier return to work and better patient satisfaction. Despite LC being a common surgical procedure, it is not totally free from complications. These include cardiorespiratory problems, biliary leakage, peritonitis, hemorrhage and superior mesenteric artery (SMA) occlusion. We report an unusual and fatal complication of LC, being SMA thrombosis complicated by multiple intra-abdominal collections, abdominal compartment syndrome, multiorgan failure and septic shock.

Postoperative Bowel Herniation in a 5-mm Nonbladed Trocar Site

Incisional hernias are a rare complication of laparoscopic surgery, with a reported incidence of <1%. We describe a case of bowel herniation and strangulation involving a 5-mm trocar site. Although there is growing literature supporting fascial closure of abdominal port sizes ≥ 10 mm, there is sparse data to suggest closure of 5-mm port sites. Our case illustrates that in appropriate clinical scenarios, the possibility of a strangulated hernia involving a 5-mm port site warrants consideration.

Retained surgical needle after laparoscopic sacrocolporectopexy: usefulness of CT fluoroscopy-guided hook-wire placement before surgical removal

Prolapse of pelvic organs is a common condition that involves the descent of one or more of the pelvic organs. In women with a combination of urogenital and rectal prolapse, laparoscopic surgery is one of the treatment options for cure.1 The increased use of laparoscopic surgery in the treatment of pelvic floor dysfunction has led to a variety of specific complications, including mesh erosion, small bowel occlusion, staple or tack migration, and bladder injuries.2–4 To the authors' knowledge, a retained surgical needle is a rare complication of laparoscopic surgery.

Strangulated small bowel hernia through the port site: A case report

Port site hernia develops through a fascial or peritoneal layer that was inadequate or not repaired. It is a rare complication of laparoscopic surgery which may lead to serious problems. Here, we present a 77-year-old female, diagnosed with a small bowel hernia through a 10-mm port site. We had performed ten cases of laparoscopy-assisted distal gastrectomy before this case. The patient complained of left lower abdominal pain with a palpable mass. Abdominal CT showed an incarcerated small bowel hernia and the patient underwent segmental resection of the strangulated small bowel through a minimally extended port site incision.

Postoperative Ascites Developing after Laparoscopic Surgery Can Become a Difficult Diagnostic Dilemma

Postoperative ascites is a rare complication of laparoscopic surgery. Life-threatening and serious etiologies such as unrecognized bowel or urinary tract injury should be excluded promptly to avoid prolonged morbidity and even mortality. Occasionally, no definitive cause can be identified after an extensive diagnostic work-up. In such cases, idiopathic allergic or inflammatory peritoneal reaction may be the final diagnosis.

Cystic duct leak after laparoscopic cholecystectomy. A multi-institutional study.

Cystic duct leak is a rare complication of laparoscopic surgery. To study the incidence, presentation, and management of cystic duct leak (CDL) after laparoscopic cholecystectomy (LC) a retrospective study of centers doing large numbers of LC was done. Patient information was obtained by a questionnaire sent to experienced laparoscopic surgeons. This queried demographic information, course of the original operation, presentation, diagnostic studies, and management of CDL after LC. Some 22, 165 LCs were performed by 24 surgeons; there were 58 cases of CDL (0. 26%); 21% of the surgeons reported no CDLs; 60% of CDLs occurred in the first 25% of each surgeon's experience, but CDLs continue to occur even in their most recent 10% of cases. Preoperative symptoms, prior surgery, and comorbid conditions did not predict CDL. Acute cholecystitis was present at initial surgery in 47%. Symptoms of CDL an average of 3.1 days post-LC were abdominal pain 78%, fever 26%, nausea 35%, vomiting 22%, abdominal distention 26%, and shoulder pain 12%. WBCs and LFTs were elevated in more than two-thirds of the cases. ERCP was most frequently used to diagnose CDL (53%) and was successful in 97%, although sonogram (40%) and HIDA scan (26%) and CT (26%) were also used. Management included ERCP and ductal decompression in 27 patients, percutaneous drainage in 13 patients, open laparotomy in 14, laparoscopy in three, and observation in two. Patients were discharged an average of 7.4 days post discovery of leak. Stents were removed an average of 30 days post ERCP. Ninety-four percent were complete cures. There was one post-treatment abscess. Two deaths due to multisystem failure unrelated to leak occurred. Cystic duct leak is rare and fairly easily diagnosed. It occurs more frequently during the learning curve, but also after much experience. ERCP and ductal decompression play a large role in treatment, but almost all standard methods of treatment yield successful outcomes with low morbidity.