SP4.1.4 Bowel injury in gynaecological laparoscopic surgery: a systematic review

Abstract

Abstract Aims Often general surgical opinion or assistance is sought in the presence of an iatrogenic bowel injury. The objective of this review was to analyse the literature on bowel injury in those undergoing laparoscopic gynaecological surgery and determine incidence rate, nature & site of injury and treatment. Methods Data sources included Pubmed, EMBASE, ClinicalTrials.gov and the Cochrane library databases. Timeframe for studies included was from 1990–2021. All studies in English reporting the incidence of bowel injury were included. Those not in English, case reports or that did not define bowel injury were excluded. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used when assessing the studies. Results Two reviewers extracted data from each study. A total of 515 papers were initially identified, 134 met inclusion criteria. Total of 512,098 laparoscopic gynae procedures were represented with 720 bowel injury reported giving an incidence rate of 1/711 (0.14%, 95% CI 0.13–0.15%) The rate of bowel injury varied with type of procedure, highest being in a hysterectomy. Small bowel was most common structure injured and the majority of bowel were identified intraoperatively. Delayed recognition of bowel injury led to high mortality rate. Conclusion The incidence for bowel injury in laparoscopy gynaecological procedures is 1/711. There is a variation in incidence rate & complexity of procedure. Early recognition and collaboration between gynaecologists and general surgeons is essential for a favourable outcome.