LAPAROSCOPIC REPAIR OF THE ENTERAL FISTULA
J. B. Mendes1, M. T. Tanaka1, O. E. H. Fugita2, P. R. Kawano2, S. C. Abreu2, G .N. Fonseca2, E. F. Carvalhal2, F. Mayer2, T. M. Siqueira Jr2
1Master Clínica, Cascavel, Brazil, 2Urolap, São Paulo, Brazil
Introduction: Bowel iatrogenic injury is a possible complication of laparoscopic surgery, and patients with prior history of abdominal surgeries are at higher risk. Successful laparoscopic repair of bowel perforation has been reported in the literature.
Method: A 34-year-old female patient underwent a laparoscopic retroperitoneal repair of an early high flow enteral fistula at the second post operative day, after an uneventful laparoscopic retroperitoneal ureterolithotomy for the removal of a 1 cm stone on the middle third of the right ureter. Her past medical history carried a remarkable series of 17 prior abdominal surgeries, including a total colectomy, followed by multiple failed attempts to perform a successful ileal continent reservoir, ending with a definitive ileosthomy. The pacient was positioned at a 90° left lateral decubitus, and approached by the same three port-sites (in line) used for the previous laparoscopy. After removing a large amount of necrotic tissues and enteric secretion with single layer interrupted 3-0 Vicryl sutures, and a laminar drain was left behind. She underwent total parenteral nutrition for a week.
Result: The operation took 70 minutes, with no further complications or fistula recurrence.
Conclusion: Laparoscopy proved to be a reliable treatment option for iatrogenic enteral fistula repair and, in this particular case, advantageous over an open procedure, which, due to the prior multiple surgeries, would have a higher risk of complications.