laparoscope - a slender, lighted telescope - to look inside the abdominal
cavity and carry out surgical procedures. Major advantages of laparoscopy over
laparotomy or open surgery include less pain after the surgery, shorter
hospital stay, and reduced blood loss.
Gynecologic laparoscopy is an alternative to
open surgery or laparotomy, which requires a large incision through the
abdominal wall to gain access to the abdominal cavity. However, laparoscopy is not without
complications, which includes injury to the bowel.
Details of the Study
Researchers selected studies and trials that
reported the incidence of bowel injury
due to gynecologic
laparoscopy procedure published between 1972 and 2014.
The studies were taken from the PubMed,
EMBASE, ClinicalTrials.gov, and Cochrane Library databases. Researches were
excluded if they were not in English or had duplicated data. Finally, as many
as 90 studies met eligibility criteria.
The analysis was aimed at determining the
rate of bowel injury in gynecologic laparoscopy, rate of mortality due to the
injury, causes of bowel injury, and location of injury within the
The systematic review recorded a total of 604
bowel injuries from the 90 studies due to gynecological laparoscopic procedure;
the incidence of the injuries worked out to 1 in 769 procedures. The rate of
bowel injury depended on the reason for the procedure, ranging from 1 in 3,333
for sterilization to 1 in 256 for the surgical removal of the uterus, known as hysterectomy
The small intestine was found to be the most
frequently damaged region of the gastrointestinal tract, with 166 injuries out
of the 354 injuries in which the location had been described.
The majority of bowel injuries occurred
during the initial stage of obtaining an abdominal access and insufflation.
This is the act of inhaling inserting gas into the body cavity using a Veress
needle or trocar placement.
Most bowel injuries were recognized
intraoperatively or during surgery, but the diagnosis was delayed by more than
24 hours in 154 of 375 cases where the time of recognition of injury was
mentioned. Bowel injuries were managed mainly by open surgery.
The researchers highlighted that death
occurred after bowel injury at a rate of 1 of 125 cases included in the study.
All deaths occurred in cases of delayed recognition of bowel injury. There were
no deaths recorded when bowel injury was diagnosed during the surgical
In their study, the researchers thus
highlight the importance of recognizing bowel injury early during gynecological
laparoscopic surgeries. The study was published in the Obstetrics & Gynecology
, the official publication of the
American College of Obstetricians and Gynecologists.
Shah AB, Milad MP. Bowel Injury in Gynecologic Laparoscopy: A Systematic
Review. Obstetrics & Gynecology: June 2015 - Volume 125 - Issue 6 - p