Management and Outcome of Rectal Injury During Gynecologic Laparoscopic Surgery

Abstract

ObjectiveTo assess the incidence and management of accidental rectal injury during gynecologic laparoscopic surgery. DesignA retrospective study with review of outcomes (Canadian Task Force classification II-3). SettingA tertiary care/research/university hospital. PatientsPatients with colon injury during laparoscopy for gynecologic diseases at Samsung Medical Center, Seoul, Korea, from January 2000 to April 2012. InterventionUse of absorbable suture or staples in primary repair of injured colon. Measurements and Main ResultsFrom January 2000 to April 2012, 12 354 patients underwent laparoscopic surgery. Rectal injury occurred in 15 women (0.12%). Their median age was 42.5 years (30–49), and the median length of injury was 3 cm (0.7–7). Among 13 patients with rectal injuries recognized during surgery, 10 patient injuries were repaired primarily with interrupted absorbable sutures without converting laparotomy, 1 patient underwent laparoscopic low anterior resection with Endo-GIA, 1 underwent open primary repair, and 1 underwent open low anterior resection. Two rectal injuries were detected after surgery. One of these patients underwent primary repair under laparotomy at day 4 after surgery. The other patient had development of a rectovaginal fistula requiring open segmental resection 30 days after primary laparoscopy despite conservative management, including percutaneous drainage and prophylactic antibiotics. ConclusionRectal injury during laparoscopy in the gynecologic field can be repaired successfully without the need for a colostomy regardless of mechanism of injury and the size of injury if adequate rectal tissue is available and recognized during surgery.