ABSTRACT
Objective To explore the feasibility of removal of affected segments via laparoscopic surgery in patients with mild colorectal perforation. Methods The clinical data on sixty-one patients with colorectal perfo-ration who had been treated in our hospital between June 2006 and June 2016 were retrospectively analyzed. The patients were divided into an open surgery group(group OS,n=38)and a laparoscopic surgery group(group LS, n = 23). All the procedure-related data were collected and analyzed. P < 0.05 was considered statistically signifi-cant in this study. Results The volume of blood loss was smaller in group LS than in group OS[(100 ± 165)mL vs(200 ± 205)mL,P=0.032],hospital stay was shorter in group LS than in group OS[(7 ± 5.21)d vs.(10 ± 9.2)d ,P = 0.009],and rate of wound infection was lower in group LS than in group OS(4/23 vs. 13/38,P =0.039),while surgical duration was longer(213.7 ± 65.7 min vs. 173.5 ± 47.2 min,P = 0.047). There were no significant differences between the two groups in intraoperative blood transfusion[(0.8 ± 1.1)U vs.(0.4 ± 0.7)U , P=0.270],postoperative ICU stay[(2 ± 0.9)d vs.(2 ± 0.7)d,P=0.009],rate of postoperative complications 25/38 vs. 14/23),and hospitalization costs[(31 758 ± 29 283)yuan vs.(36 243 ± 27 584)yuan,P = 0.673]. Conclusions Laparoscopic colectomy is safe and feasible in the treatment of mild colorectal perforation.
ABSTRACT
PURPOSE: Colorectal perforation is a rare malady, but it usually presents abdominal emergency with high morbidity and mortality. It is very difficult to diagnose stercoral, idiopathic, or steroid induced perforation because these are very rare, but they show high mortality. The aims of this study are to: 1) evaluate and compare the characteristics of stercoral, idiopathic and steroid induced perforation with other perforations; and to 2) guide the diagnostic approach and treatment of these rare colon perforations. METHODS: We retrospectively reviewed thirty five patients underwent surgery for colorectal perforation at the Department of Surgery, Daedong Hospital, from November 1996 to January 2005. Age, gender, perforation site, grade of peritonitis, methods of operation and mortality rates were compared between the various causes. Logistic regression was used to evaluate their effect on mortality. RESULTS: There were 10 cases of iatrogenic colorectal injuries (28%), 7 of steroid induced colorectal perforation (20%), 5 of stab (14%), 4 of diverticulitis (11%), 4 of stercoral (11%), 3 of idiopathic (8%), and 2 of cancer induced perforation (5%). Total mortality rate of all the cases was 28.5% (10 out of 35) but the mortality of stercoral, steroid induced and idiopathic perforation was 57% (8 out of 14). The mortality rate was higher in older age group (60 years above) (40%), stercoral (75%), steroid induced (57%) and idiopathic (33%), preoperative systemic inflammatory response (SIRS) (42%), preoperative septic shock (83%), abnormal WBC count (10,000/mm3 above or 4,000/mm3 below) (53%), left colon perforation (36%) and diffuse peritonitis (56%). The mortality rate was lower in young age group (13%), iatrogenic (10%), stab (0%), right colon perforation (10%) and localized peritonitis (5%). The peritonitis grade (Hinchey's stage) of idiopathic group, cancer and stercoral was worse (III-IV grade: 75%, 100%, 75%) than that of diverticulitis, iatrogenic and stab (III-IV grade: 25%, 30%, 40%). CONCLUSION: The stercoral, steroid induced and idiopathic colorectal perforation was rare, difficult to diagnose but it showed high mortality. The characteristics of these are an older age, presenting with a high peritonitis grade, preoperative SIRS, preoperative septic shock, and occurrence below the splenic flexure. If surgeons encounter these perforations, they should perform prompt surgical management and intensive postoperative care to reduce the mortality.