NONBILIARY LAPAROSCOPIC GASTROINTESTINAL SURGERY - ROLE OF CT IN DIAGNOSIS AND MANAGEMENT OF COMPLICATIONS

OBJECTIVE. Laparoscopic techniques are evolving for a wide range of su rgical procedures outside the biliary tree. We describe the CT finding s of important complications detected after nonbiliary laparoscopic ga strointestinal surgery and the role of CT in their management. MATERIA LS AND METHODS. Over a 3-year period, 209 patients had nonbiliary gast rointestinal laparoscopic procedures (partial or total colectomy, sple nectomy, Nissen fundoplication, lymph-node dissection, herniorrhaphy, appendectomy, and exploratory laparoscopy). Thirty-seven abdominopelvi c CT studies were performed on 18 (9%) of these patients for complicat ions after surgery. In all cases CT findings were reviewed and correla ted with follow-up surgical, clinical, or interventional radiologic fi ndings. RESULTS. Fourteen major complications were detected on CT in 1 2 of 18 (67%) patients who had undergone partial or total colectomy (6 /25, 24%), splenectomy (4/41, 10%), appendectomy (1/15, 7%), or lymph- node dissection (1/43, 2%). These complications included seven abscess es (three of the splenic bed, two of the pelvis, one of the liver, and one of the abdominal wall). The remaining complications were four hem atomas (two in the abdominal wall caused by trocar site bleeding, one intraperitoneal, and one retroperitoneal), one case of colon perforati on, one case of pancreatitis, and one case of splenic infarction. Perc utaneous abscess drainage was performed successfully in seven patients , using CT guidance in six. Six patients had negative CT studies. CONC LUSION. Major complications may occur after complex nonbiliary laparos copic procedures and are probably related to lack of experience with n ew surgical techniques. In this study, such complications occurred mos t often after laparoscopic colectomy and splenectomy. CT was valuable in their diagnosis and in the management of abscess collections.