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 23 May 2018

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News

Mortality due to bowel injuries during gynecological laparoscopy may be underestimated

Bowel injury during gynecological laparoscopy is significantly related to the experience of the surgeon, and mortality due to trauma may be underestimated in some reports, claims a team from Belgium and England.

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The researchers evaluated the prevalence, causes, sites, management, and outcomes of bowel injury occurring during, or as a result of, gynecological laparoscopy.

They reported their findings in the June issue of Gynaecological Endoscopy.

A questionnaire was sent to members of the International Society for Gynecologic Endoscopy (ISGE). It requested details of all laparoscopies complicated by bowel trauma and performed by them over a 2-year period.

One year was retrospective and one prospective.

A total of 135 members (24%) replied, and reported 45 bowel injuries.

The estimated prevalence was found to be 1 in 1652 for level 1 laparoscopies, and 1 in 280 for levels 2 and 3 laparoscopies combined.

Injuries were caused by the Veress needle, primary trocar, forceps, scissors, and by electro- and laser surgery.

Adhesions from previous surgery or endometriosis were present in 78% of cases.

Bowel trauma was significantly related to the experience of the surgeon, defined by a cut-off at 100 procedures per year.

The researchers found that, in experienced hands, trauma occurred as frequently during access as during the surgical procedure.

The diagnosis was made during the laparoscopy in 38 cases.

Expectant treatment was carried out in 4 cases after Veress needle injury without consequences, laparoscopic suturing in 8 cases, and conversion to laparotomy in 26 cases.

The diagnosis was delayed in 7 patients (15%), of whom 2 (28%) died 7 days after surgery without any further intervention.

Ivo Brosens, of the Catholic University of Leuven, Belgium, said on behalf of fellow colleagues, "Bowel injury during gynecological laparoscopy is significantly related to the experience of the surgeon.

"With the experienced group, bowel trauma occurs as frequently during access as during the surgical procedure.

"The occurrence of 2 deaths in our study suggests that the mortality due to bowel trauma may be underestimated in reports from highly privileged societies," it was concluded.

Gynaecological Endoscopy 2001; 10 (3): 141-5
23 July 2001

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