Colostomy-Free Bowel Injury Repair.

Abstract

<h3>Study Objective</h3> To examine procedures of bowel repair after accidental bowel injury during gynecologic surgery and consider the role of colostomy. Demonstrate the appropriate management of accidental bowel injuries. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Urban general hospital in Japan. <h3>Patients or Participants</h3> From January 2010 to December 2020, 7,154 underwent laparoscopic or robotic hysterectomy for benign pathology. From these cases, the videos of surgeries where bowel injury was experienced were viewed. <h3>Interventions</h3> 21 cases suffered an intraoperative bowel injury that may normally be recommended for colostomy. These cases were managed by same-session intraoperative repair. In one case where multiple bowel injuries occurred during vaginal retrieval, a colostomy was performed. In the other 20 cases, intraoperative repair was safely completed, and no patients experienced pan-peritonitis after the original surgery. It is important to suture the bowel in two layers. Needle driving needs to be precise with the driving and pull-through perpendicular to the bowel wall. Tissue involvement needs to be both precise and consistent across all sutures. The seromuscular suture is placed to push the mucosa into the lumen. In very severe cases we use LAR (one case). After trimming of the damaged cut end of the rectum, a double stapling technique is very effective for event free anastomosis. <h3>Measurements and Main Results</h3> One case experienced leakage from the repair site and this was resolved with drainage and no colostomy was required. All other patients had an event-free recovery. <h3>Conclusion</h3> Bowel injuries have been routinely managed by colostomy. In our series, we have examined the effectiveness of our methods of repair without using colostomy and have found that when repair is sound, colostomy is not required. Colostomy-free surgery is more patient friendly and should be practiced in scenarios where repair training is adequate and suture repair can be performed safely.