Management and Outcome of Colon Injury during Laparoscopic Surgery in Gynecologic Field

To assess the incidence and management of accidental large bowel injury during laparoscopy in gynecologic field. A retrospective study with review of outcomes (Canadian task classification II-3). A university hospital, research hospital, and a tertiary care center. Patients with colon injury during laparoscopy for gynecologic diseases at Samsung Medical Center, Seoul, Korea, from January 2000 to March 2012. Use of absorbable suture or staples in primary repair of injured colon. From January 2000 to March 2012, 6070 patients underwent laparoscopy. Of these, colon injury occurred in 15 women. Median age was 42.5(30-49) and the median length of injury was 3cm (0.7-7). Among 13 patients recognized intra-operatively, 10 patients were repaired laparoscopically with absorbable suture, one underwent laparoscopic low anterior resection and one underwent open low anterior resection. Two colon injuries were unrecognized during surgery and were detected postoperatively. One had undergone primary repair under laparotomy at day 4 after surgery. Despite conservative management (NPO, percutanous drainage, prophylactic antibiotics), one had developed the recto-vaginal fistula and ileus requiring open segmental resection in 30 days after primary laparoscopy.Tabled 1Characteristics, management and outcome of colon injuryCase no.AgeSurgeryRecognitionLocationManagementLength injury(cm)Outcome146LAVHimmediaterectumAnoscopic primary repairNAsuccess247LRHimmediaterectumTransvaginal primary repairNAsuccess344LAVHimmediaterectumLaparoscopic primary repair3success449LAVHimmediatesigmoid colonOpen LAR5success547LAVHimmediaterectumTransvaginal primary repairNAsuccess645LAVHimmediaterectumTransvaginal primary repairNAsuccess747LAVHimmediaterectumTransvaginal primary repair1success838LAVHimmediaterectumOpen primary repair7success930LAVHimmediaterectumTransvaginal primary repair3success1038LARVTPOD#3ileumOpen primary repair0.7success1141LAVHimmediaterectumTransvaginal primary repairNAsuccess1249LAVHimmediaterectumTransvaginal primary repairNAsuccess1341LAVHimmediaterectumTransvaginal primary repair3success1438LAVHPOD#2rectumNPO,PCDNAfail1544LMimmediaterectumLaproscopic LAR3successLM, laparoscopic myomectomy; LAVH, laparoscopy assisted vaginal hysterectomy; LRH, laparoscopic radical hysterectomy; LARVT, laparoscopic assisted radical vaginal trachelectomy; LAR, low anterior resection; POD, postoperative day; NPO, no per oral; PCD, percutaenous drainage; NA, not available Open table in a new tab LM, laparoscopic myomectomy; LAVH, laparoscopy assisted vaginal hysterectomy; LRH, laparoscopic radical hysterectomy; LARVT, laparoscopic assisted radical vaginal trachelectomy; LAR, low anterior resection; POD, postoperative day; NPO, no per oral; PCD, percutaenous drainage; NA, not available Colon injury is an infrequent complication of laparoscopy in gynecologic field. When recognized intra-operatively and primarily repaired, no recto-vaginal fistula or postoperative complications were presented. In woman with unrecognized colon injury, the recto-vaginal fistula tended to persist and eventually required delayed surgical repair.