Bowel injuries during gynaecological laparoscopy: a multinational survey

Abstract

Objective To use the experience of an international group of gynaecological laparoscopists to evaluate the prevalence, causes, sites, management and outcomes of bowel injury occurring during or as a result of laparoscopy. Design A questionnaire was sent to members of the International Society for Gynecologic Endoscopy (ISGE) requesting details of all laparoscopies complicated by bowel trauma and performed by them over a 2-year period. One year was retrospective and one prospective. Results A total of 135 members (24%) replied and reported 45 bowel injuries. The estimated prevalence was 1 in 1652 level 1 laparoscopies and 1 in 280 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 statistically significantly related to the experience of the surgeon, defined by a cut-off at 100 procedures per year. 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 four cases after Veress needle injury without consequences, laparoscopic suturing in eight cases and conversion to laparotomy in 26 cases. The diagnosis was delayed in seven patients (15%) of whom two (28%) died 7 days after surgery without any further intervention. Conclusions Bowel injury during gynaecological 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 two deaths in our study suggests that the mortality due to bowel trauma may be underestimated in reports from highly privileged societies.