Identification of peritoneal reflection and treat ment of peritoneal injury in retroperitoneal laparoscopic surgery

Men Qunli; Guo Gang; Cai Wei; Zhu Qiang; Liu Peng; Zhang Xu

Abstract：To analyze the anatomical features of reflection in retroperitoneal laparoscopy and reasons of peritoneal rupture ,and explore the prevention and treatment of intraoperative peritoneal rupture in retroperitoneal laparoscopy .Methods :Peritoneal rupture status ,location and treatments in 483 patients from 2013 February to 2013 October in Chinese PLA General Hospital were retrospecti vely analyzed .Retroperitoneal anatomical characteristics of peritoneal rupture were studied through the literature review.Results :Fifty-three patients (37 males ,and 16 fe-males )with the age of 19-78 years old experienced intraoperative peritoneal rupture in retroperitoneal laparoscopic surgery with the incidence being 11.0 %.There were 21 cases on the left side ,and 32 on the right side .The perito-neal rupture was located under the diaphrag min 9 cases ,in kidney ventral area in 41 cases ,and in renaliliac fossa area in 3 cases .Forty cases under went nephrecto my ,8 cases adrenalecto my ,and 5 cases renal pelvis and ureter sur-gery .Peritoneal rupture occurred during the retroperitoneal preparati on and trocar placement in 8 cases ,and in 45 cases odue to improper operati on .All of these cases did not experience intraoperative peritoneal lesions .After perito-neal rupture ,the peritoneal around the crevasse was fully dissociated ,abdo minal pneu matosis was ter minated ,the peritoneal crevasse cli pped with separating pliers after lacerati on occl usi on ,and finally the peritoneal crevasse was cli pped with He m-o-l ok .For larger crevasse ,the abdo minal pressure was deco mpressed through abdo minal puncture with silk ,then peritoneal crevasse was cli ppd with He m-o-l ok or sutured .Fifty 53 cases of peritoneal rupture suc-cessfully under went retroperitoneal laparoscopic surgery without postoperative peritoneal rupture-related co mplica-ti ons .Conclusions :Peritoneal rupture is a common complicati on during retroperitoneal laparoscopic surgery .The inci-dence of the peritoneal rupture can be effecti vely reduced probably by accurately identifying the peritoneal reflection . And a variety of methods can deal with peritoneal rupture effecti vely.