Bowel injury in gynecologic laparoscopy

Study Objective. To review surveys of the last decade on bowel injuries to evaluate the prevalence, causes, management, and outcomes of these events occurring during or as a result of laparoscopy. Design. Retrospective evaluation (Canadian Task Force classification II-2). Setting. Surveys and databases. Patients. None. Intervention. Data analysis. Measurements and Main Results. Combined data show that diagnostic and minor operative laparoscopy are associated with a 0.08% risk of bowel injury, and in major operative laparoscopy the risk increases to 0.33%. Injuries occurring during access and operative procedure decrease significantly with experience, but even in experienced hands injury during access cannot be avoided. Delayed diagnosis remains a major problem. Up to 15% of these injuries are not diagnosed during laparoscopy, and one of five cases of delayed diagnosis results in death. Perioperative diagnosis and immediate repair by laparoscopy or laparotomy reduce the likelihood of severe complications and consequently medicolegal actions. Conclusion. Several surveys on complications of gynecologic laparoscopy tend to underestimate the risk of bowel injury. Prevention starts by awareness that such injury is an inherent risk of the technique, even in hands of experienced surgeons.