Small bowel obstruction secondary to stapled laparoscopically assisted vaginal hysterectomy

Background: This study analyzes the complication of small bowel obstruction following stapled division of the adnexa during laparoscopically assisted vaginal hysterectomy (LAVH). Methods: We reviewed the records of three patients with small bowel obstruc tion following stapled LAVH. We then tested the proposed mechanisms of obst ruction by firing endoscopic staplers across silicon tubing to simulate div ision of the adnexal structures. Staple shape, spillage, and closure were a nalyzed. Results: Small bowel obstruction can result when a partially formed endosco pic staple hooks the small bowel. The problem can be traced to either spill ed intraperitoneal staples or partially formed staples that adhere to part of the adnexal staple line. The mechanisms staple closure, spillage, and ab ility to hook small bowel were confirmed with a laboratory model. Conclusions: Techniques for reducing: the incidence of small bowel obstruct ion following stapled LAVH include minimizing Staple spillage and careful i nspection of the adnexal staple line for partially formed staples.