Laparoscopic bowel injury in retroperitoneal surgery: current incidence and outcomes

Laparoscopic bowel injury is associated with significant morbidity and mortality when unrecognized. We assessed the incidence and outcomes of bowel injury in a contemporary cohort of patients, and reviewed the literature to examine the impact of experience with time on the incidence and consequences of bowel injury.

Between 2006 and 2009 we performed 1,073 laparoscopic surgeries on the upper urinary tract, adrenal gland and retroperitoneal lymph nodes. Patients incurring bowel injury were identified retrospectively. We reviewed complications and management. In a separate literature survey we identified 21 studies on laparoscopic bowel injury from 1993 to 2009. We analyzed etiology, incidence and management.

Bowel injury occurred in 8 cases (0.75%), including 6 and 2 identified intraoperatively and postoperatively, respectively. Mechanisms included Veress needle and trocar placement, dissection and thermal injury. Intraoperative management included oversewing the injury, bowel resection and observation. No patient with intraoperatively recognized bowel injury sustained a postoperative adverse event. Patients with unrecognized injury presented in delayed fashion and required multiple procedures to manage the injury. No deaths occurred in this series. Urology series of bowel injury showed a combined 0.65% incidence in 14,447 laparoscopic procedures with 46.7% of injuries unrecognized at surgery. While the incidence of bowel injury has increased with time, the percent of unrecognized bowel injury has dramatically decreased from the early (70.4%) to the more recent (36.9%) laparoscopic era.

The incidence of laparoscopic bowel injury has increased in the last 17 years. However, morbidity and mortality have decreased due to immediate recognition and repair.