KAHRAMAN ÜLKER, ÖZGÜR AKSOY, Ürfettin HÜSEYİNOĞLU, CELAL ŞAHİN ERMUTLU, BARLAS SULU, ENGİN KILIÇ

Rectal catheterization for the diagnosis of Iatrogenic descending colon injuries during CO2 laparoscopy: An experimental study

CO2 laparoskopisi sırasındaki barsak yaralanmalarının ancak %35.7si ameliyat sırasında fark edilebilmektedir. Yaralanmaları teşhis edebilmek amacıyla rektuma hava verilmesi düşünülse de, bu uygulama kontamine barsak içeriğinin yayılma şansını arttırabilir. Bu deneysel çalışmada CO2 laparoskopisinde rektal kateterizasyonun küçük ya da fark edilmeyen barsak yaralanmalarındaki rolünü belirlemeyi amaçladık. Yedi tane beyaz, dişi Yeni Zelanda tavşanının karnı 12 mmHg basınca erişene kadar gazla şişirildi. Ucu idrar torbasına sıkıca bağlanmış 8 G idrar sondası tavşan rektumuna yerleştirildi. Bir 21 G iğnenin ucuyla inen kolon delindi. Deney süresince CO2 kullanımı ve idrar torbasında izlenen hacim değişiklikleri kaydedildi. Torbaya akışı göstermek için metilen mavisi kullanıldı. Kolonun delinmesinden sonra anlamlı miktarda gaz idrar torbasında birikti ve metilen mavisi kateter içine aktı. Bu bulguya göre, transanal uygulanan ve idrar torbasına bağlanan bir kateter, laparoskopik cerrahi sırasında oluşabilecek küçük ya da fark edilmeyen barsak yaralanmalarının tanısında yardımcı olabilir.

CO2 Laparoskopisi sırasında intraoperatif barsak yaralanmalarının tanısı için rektal kateterizasyon: Deneysel bir çalışma

Only 35.7% of the bowel injuries occurred during CO2 laparoscopy is noticeable intra-operatively. Although air insufflations into the rectum is suggested to identify this injuries, increased risk of contamination of the abdominal cavity by bowel contents makes this procedure abolished. In this experimental study we aimed to evaluate the role of rectal catheterization in the diagnosis of small or unnoticed injuries of the intestines during CO2 laparoscopy. Pneumoperitoneum was created at a pressure level of 12 mmHg in seven white, New Zealand female rabbits. An eight G urinary catheter connected tightly to a urine bag was introduced into the rectum. The descending colon was perforated with the tip of a 21 G needle. Timely CO2 use and the change of urine bag volume were recorded. Methylene blue was used to demonstrate flow into the bag. Significant amounts of gas accumulated in the urinary bag following the perforation of the large bowel and methylene blue flowed into the catheter. Thus, transanal placement of a catheter connected to a urinary bag may help in the diagnosis of small or unnoticed large bowel injuries during laparoscopy.

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