The report of 3 cases rectal injury during radical prostatectomy

Abstract

Objective To report the experience of rectal injury during laparoscopic radical prostatectomy(LRP). Methods The clinical data for 3 patients with iatrogenic rectal injury in LRP in our hospital between January 2015 and October 2018 were retrospectively analyzed. The data of these three patients were as follows: age 69-79 year, mean 74.3 year; BMI 25.6-28.6 kg/m2, mean 27.1 kg/m2; preoperative PSA 5.7-74.1 ng/ml, mean 32.7 ng/ml; prostate volume 55.2-80.3 ml, mean 65.3 ml; preoperative TMN stage T1b-3aN0M0, preoperative Gleason score 6-8. One patient received neoadjuvant hormonal therapy; one patient did HoLEP three month before LRP. Surgical method: When rectal injury was noted, we continued our dissection between the correct layers until prostatectomy was completed. Then the wound in the rectum was thoroughly checked and irrigated with diluted povidone iodine. The wound was trimmed according to the wound condition, and the suture was conducted by absorbable silk at three layers: the rectal mucosa layer, the outer layer of the rectal wall, the posterior layer of the fascia. Then we rinsed the wound with iodophor and completed the urethral reconstruction. Results The operative time was 138-210 min, mean 166.7 min, and repair time was 30-41 min, mean 34.3 min. The intraoperative blood loss was 110-215 ml, mean 158.3 ml. Rectal injury occurred during prostatic apical dissection in 1 patients, during dissection of Denonvilliers fascia in 2 patient. The size of the lesions was 1.0-1.5 cm, mean 1.2 cm. All of the rectal injuries were recognized during the operation, and three-layered sutures were used for the primary repair. None of the cases required ileostomy procedure. Diet recovery time was 6-7 d, mean 6.3 d. The duration of transurethral catheter insertion was 10-14 d, mean 12.3 d. The pathological stage was T2~3bN0M0, pathological Gleason score 6-9, and 1 case surgical margin positivity in the apical region of the prostate. No case occurred urorectal fistulas.2 cases received adjuvant androgen deprivation therapy. Conclusions Primary repair with laparoscopic three-layered suturing might be sufficient for the treatment of rectal injuries that occur during LRP if the lesion was small and the margin was clean. Key words: Prostatectomy; Laparoscope; Rectal injury