OBJECTIVE: To assess the incidence and management of accidental rectal injury during gynecologic laparoscopic surgery. DESIGN: A retrospective study with review of outcomes (Canadian Task Force classification II-3). SETTING: A tertiary care/research/university hospital. PATIENTS: Patients with colon injury during laparoscopy for gynecologic diseases at Samsung Medical Center, Seoul, Korea, from January 2000 to April 2012. INTERVENTION: Use of absorbable suture or staples in primary repair of injured colon. MEASUREMENTS AND MAIN RESULTS: From 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. CONCLUSION: Rectal 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.
OBJECTIVE: To assess the incidence and management of accidental rectal injury during gynecologic laparoscopic surgery. DESIGN: A retrospective study with review of outcomes (Canadian Task Force classification II-3). SETTING: A tertiary care/research/university hospital. PATIENTS: Patients with colon injury during laparoscopy for gynecologic diseases at Samsung Medical Center, Seoul, Korea, from January 2000 to April 2012. INTERVENTION: Use of absorbable suture or staples in primary repair of injured colon. MEASUREMENTS AND MAIN RESULTS: From 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. CONCLUSION:Rectal 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.