Major postoperative complications secondary to use of the Bookwalter self-retaining retractor

To report on five serious intraoperative damages to nonprocedure-related organs during 10 years of experience with the Bookwalter device. Self-retaining retractors are helpful devices, particularly during major transperitoneal and retroperitoneal operations. Various retractors are available and allow the use of all combinations of blades to maintain exposure during each step of an operation. Furthermore, by using these devices, most operations can be performed by two surgeons only.

With the help of the operation protocols, more than 4000 applications of the Bookwalter device between January 1992 and December 2001 were retrospectively reviewed. Four cases with damage to the large bowel and one of femoral neuropathy were documented.

In one transperitoneal and three retroperitoneal approaches, serious damage to the large bowel occurred. None was recognized before postoperative days 2 and 7. One femoral neuropathy was noted.

The Bookwalter self-retaining retractor is a helpful and safe device in exposing the intraoperative situs. However, care must be taken in patients with risk factors, such as immunosuppression and diverticulitis, and particularly in retroperitoneal operations when tightening the blades. When the intra-abdominal cavity is not exposed, damage to other organs may not be directly noted, which could explain the delay of several days to the onset of symptoms.