Gastrointestinal injuries during gynaecological laparoscopy

A retrospective case review study was carried out on gastrointestinal injur ies which occur during gynaecological laparoscopy. Fifty-six patients with 62 gastrointestinal injuries were identified. One-third of the complication s (32.2 %) occurred during the installation phase for laparoscopy. Four of the six complications attributed to electrosurgery were secondary to the us e of monopolar coagulation. Diagnosis of these gastrointestinal injuries wa s made during surgery in only 20 patients (35.7%). The mean time before dia gnosis was 4.0 +/- 5.4 (range 0-23) days. Treatment of these complications was performed by laparoscopic surgery in 16.1% of cases. Prevention relies on the surgeon's experience, strict observance of the safety rules, perfect familiarity with the physical properties of the instruments used, systemat ic use of bowel preparation for patients presenting a risk of bowel complic ations, systematic supervision of the route taken by the trocars, meticulou s inspection on completion of surgery of all areas where bowel adhesiolysis has been used and, in case of any doubt, tests for leakage involving the r ectosigmoid. For patients with a risk of bowel complications, the creation of a pneumoperitoneum and performing a mini laparoscopy in the left hypocho ndrium can be the judicious option.