No abstract available.
Peritoneal Lavage*

No abstract available.
Peritoneal Lavage*

The usefulness of peritoneal lavage in the identification of patients who require laparotomy after close abdominal trauma is not controversial. Peritoneal lavage should be seen as an adjunct to clinical presentation poses unusual difficulty, for example, when consciousness in impaired or when diagnostic doubt exists... The diagnostic accuracy of peritoneal lavage in blunt abdominal trauma has been shown of 100%. In this collected of 17 patients, the false positive rate was 0%.
Peritoneal Lavage ; Abdominal Injuries ; diagnosis

OBJECTIVETo investigate the relationship of positive rate of peritoneal exfoliated gastric cancer cells with the volume of peritoneal lavage fluid.

METHODSExfoliative cytology of peritoneal lavage was performed at the time of laparotomy for 185 patients with gastric cancer from June 2012 to March 2014 in our department, and the clinicopathological data were analyzed retrospectively. According to the volume of saline irrigation, patients were divided into 200 ml group (40 cases), 500 ml group (45 cases) and 1000 ml group (100 cases). The positive rates of peritoneal exfoliated cells among three groups were compared, and then the associated clinicopathological factors were further analyzed in the highest group.

RESULTSThe positive rates of exfoliated cancer cells were 5%(2/40),11%(5/45) and 19%(19/100) in the 200 ml group, 500 ml group and 1000 ml group respectively. The positive rate of exfoliated cancer cells was highest in the 1000 ml group, and was significantly different as compared to the 200 ml group(P=0.036), but not significantly different as compared to the 500 ml group (P>0.05). Multivariate Logistic regression analysis of 1000 ml group showed that age less than sixty years(OR=12.31, 95% CI:2.05-74.11, P=0.006), circumferential infiltration(OR=0.09, 95% CI:0.01-0.84, P=0.034) and T4 (OR=0.09, 95% CI:0.01-0.56, P=0.010) were independent risk factors for positive rate of exfoliated cancer cells.

CONCLUSIONSGreater volume of saline irrigation can improve the positive rate of peritoneal exfoliated cells in gastric cancer especially for patients with younger age, circumferential infiltration and serosal invasion. The recommended volume should not be less than 1000 ml.

BACKGROUND/AIMS: Peritoneal dissemination is the most frequent type of recurrence in gastric cancer after curative surgery. Such recurrences may be attributable to possible intra-peritoneal dissemination of malignant cells. The aim of this study was to investigate the role of diagnostic laparoscopy and peritoneal lavage cytology to detect intra-peritoneal dissemination pre-operatively in the staging of advanced gastric cancer. METHODS: Laparoscopy and peritoneal lavage was performed in patients with advanced gastric adenocarcinoma after noninvasive staging had shown no irresectable locoregional disease and/or distant metastases. The peritoneal cavity was washed and allowed to collect during laparoscopic examination and stained by Papanicolaou methods. The results were compared with TNM stage, size of cancer, endoscopic diagnosis, and histologic type. RESULTS: Thirty-three patients were included. Peritoneal metastasis and intra-peritoneal free cancer cells were proven histo/ cytologically in seven patients (21.2%) and cytologically only in three patients (9.1%). All of these patients were stage IIIB or stage IV and showed higher stages than cytologically negative patients (p<0.01). CONCLUSIONS: Laparoscopic staging in advanced gastric cancer patients may be a good diagnostic method to detect intra-peritoneal dissemination. Detection of intra-peritoneal free cancer cells may suggest more advanced stage of gastric cancer. Peritoneal lavage cytology may be used to predict a serosal or direct invasion to adjacent organs.
Adenocarcinoma ; Diagnosis ; Humans ; Laparoscopy ; Neoplasm Metastasis ; Peritoneal Cavity ; Peritoneal Lavage ; Recurrence ; Stomach Neoplasms

Gastric cancer with positive peritoneal cytology is a hotspot in the study of gastric cancer, and its prognosis is poor. Intraperitoneal free cancer cells may be associated with cancer cells migration, invasion and metastasis. Tumor T stage, peritoneal metastasis, lymph node metastasis, low histological differentiation, linitis plastica, adenocarcinoma of esophagogastric junction, and operation are the clinicopathological risk factors of gastric cancer with positive peritoneal cytology. Currently, the acquisition of free cancer cells is mainly through diagnostic laparoscopy combined with peritoneal lavage, and cytopathological examination is gold standard for diagnosis. Its treatment strategies are not in consensus, including preoperative chemotherapy combined with radical resection, postoperative chemotherapy and peritoneal local treatment, which can prolong the survival of patients. At present, postoperative chemotherapy is often used in China, and the best treatment strategies remain to be further studied.
China ; Gastrectomy ; Humans ; Neoplasm Staging ; Peritoneal Lavage ; Peritoneal Neoplasms/diagnosis* ; Prognosis ; Retrospective Studies ; Stomach Neoplasms/surgery*

BACKGROUND: Although diagnostic peritoneal lavage (DPL) is a well-established, reliably objective method of diagnosis of intraperitoneal injury, it is too sensitive to be used as a absolute indicator for emergency laparotomy. Recently, Otomo et al, have devised a new DPL criteria specifically designed and modified the classics criteria to aid in diagnosis of intestinal injury. So the author studied the difference of diagnostic sensitivity, specificity, and accuracy between the new and classic criteria for intestinal injury. METHODS: The author reviewed retrospectively one hundred fifteen patients underwent DPL from January 1993 to August 1999. The author adopted the classic criteria positive for intestinal injury when the lavage fluid was white blood cell(WBC) > or = 500/mm3 and newly developed supplementary criteria positive when RBC > or = 100,000/mm3, the positive-negative borderline was adjusted to WBC > or = RBC/150, and when RBC <100,000/mm3, to WBC > or = 500/mm3. And analyzed the difference of sensitivity, specificity, and accuracy each other. RESULTS: Among 115 patients, the sensitivity, specificity, and accuracy for intestinal injury were 96.4%, 87.4%, and 89.6% for the new criteria, and 100%, 42.5%, and 56.5% for the classic criteria. After exclusion of 10 patients in whom-DPL was performed within 3 hours or after 18 hours from the time of injury, the sensitivity, specificity and accuracy for intestinal injury were 96.4%, 97.4%, and 97.1% for the new criteria, and 100%, 46.8%, and 61% for the classic criteria. When analyzed the time interval from injury to DPL in the new criteria, 105 patients that DPL was performed between 3 to 18 hours had 2 false-positive, while 115 patients regardless of DPL time 11 false-positive. CONCLUSIONS : The author concluded that the new criteria of DPL effluent performed between 3 to 18 hours from abdominal blunt trauma would be more specific and accurate indicator of intestinal perforation than the classic criteria. And this new criteria will be used as a reliable indicator for emergency laparotomy for that patients.
Diagnosis ; Emergencies ; Humans ; Intestinal Perforation ; Laparotomy ; Peritoneal Lavage* ; Retrospective Studies ; Sensitivity and Specificity ; Therapeutic Irrigation

PURPOSE: There has been debate on the use of peritoneal irrigation and drainage following gastric cancer surgery. This study was conducted to evaluate the usefulness of routine peritoneal irrigation and drainage following gastric cancer surgery, especially with regard to the perioperative leukocyte count. METHODS: Of 298 patients, 153 were enrolled in the test group (without peritoneal irrigation & drainage), between October 2001 and August 2002, and 145 in the control group (with peritoneal irrigation and drainage), between January 2001 and September 2001. The demographics, range of dissection, pathological staging, operation times, anesthesia times, fever, perioperative leukocyte counts and operative complications were retrospectively analyzed in these consecutive patients. RESULTS: It was found that there was no difference in the demographics, range of dissection, pathological staging and operative complications between the two groups. However, the operation times, anesthesia times, and mean length of hospitalization in the test group were significantly shorter than those in the control group. No significance differences were found between the two groups with regard to the perioperative leukocyte counts. CONCLUSION: The routine usage of peritoneal irrigation and drainage was found to be neither safe nor effective in gastric cancer surgery patients.
Anesthesia ; Demography ; Drainage* ; Fever ; Hospitalization ; Humans ; Leukocyte Count* ; Leukocytes* ; Peritoneal Lavage* ; Retrospective Studies ; Stomach Neoplasms*

BACKGROUND: Evaluation of blunt abdominal trauma is clinically challenging. Diagnostic peritoneal lavage (DPL) and computed tomographic (CT) scanning have become primary diagnostic modalities. We examined the efficacy and the role of ultrasonographic (US) studies in the initial abdominal evaluation of blunt abdominal trauma. METHODS: We, therefore, retrospectively reviewed 87 patients who sustained blunt abdominal trauma from October 1996 to August 1997. RESULTS: Ultrasonography showed a sensitivity of 89.7% and a specificity of 98.3%. The accuracy was 95.4%. The positive predictive value was 96.3%, and the negative predictive value was 95.0%. CONCLUSIONS: Ultrasonography saves time and money, can be performed in the emergency department, shows high sensitivity and specificity, and is the best method of first choice in the evaluation of blunt abdominal trauma. We believe that abdominal US should be considered an important tool and an integral part in the work-up for major trauma victims.
Emergencies* ; Emergency Service, Hospital ; Humans ; Peritoneal Lavage ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography*

PURPOSE: Despite the great advances in laparoscopic techniques, most active general surgeons do not apply laparoscopic surgery in the treatment of duodenal ulcer perforation when facing a real-life emergency. Therefore, our study was designed to evaluate the feasibility of laparoscopic surgery in duodenal ulcer perforation, and provide a step-by-step protocol with tips and recommendations for less experienced surgeons. MATERIALS AND METHODS: Between March, 2011 and May, 2012, 21 patients presenting with duodenal ulcer perforation underwent laparoscopic primary repair with omentopexy. There were no contraindications to perform laparoscopic surgery, and the choice of primary repair was decided according to the size of the perforation. The procedure for laparoscopic primary repair with omentopexy consisted of peritoneal lavage, primary suture, and omentopexy using a knot pusher. RESULTS: During the operation, no conversion to open surgery or intra-operative events occurred. The median operation time was 45.0 minutes (20~80 minutes). Median day of commencement of a soft diet was day 6 (4~17 days). After surgery, the median hospital stay was 8.0 days (5~27 days). Postoperative complications occurred in one patient, which included a minor leakage. This complication was resolved by conservative management. CONCLUSIONS: Although our study was carried out on a small number of patients at a single institution, we conclude that laparoscopic primary repair can be an effective surgical method in the treatment of duodenal ulcer perforation. We believe that the detailed explanation of our procedure will help beginners to perform laparoscopic primary repair more easily.
Conversion to Open Surgery ; Diet ; Duodenal Ulcer ; Emergencies ; Humans ; Laparoscopy ; Length of Stay ; Peritoneal Lavage ; Postoperative Complications ; Sutures