Gastric Or Duodenal Injuries

Inadvertant injury to the stomach can occur specifically during left nephrectomy or adrenalectomy. A small gastric perforation can be closed by intracorporeal laparoscopic purse-string suturing, if the surgeon is comfortable with laparoscopic suturing technique.

An abdominal drain is placed adjacent to the repaired site and the stomach is decompressed with a nasogastric tube. Injury to the duodenum during Kocherization is a very serious complication because duodenal leak has high morbidity and a potential mortality.

Duodenal injury occurs most frequently during renal surgery on the right side or during laparoscopic retroperitoneal lymphadenectomy. Duodenal injury is managed by open conversion and repair of the duodenal injury along with placement of an abdominal drain.

It may necessitate resection of a segment of the duodenum and duodenojejunal anastomosis. Intraoperative general surgical consultation is mandatory. Total parenteral nutrition may also be necessary. Gentle handling of tissues and avoidance of the use of energy close to the bowel segment should prevent the above injuries. Duodenal injury can be avoided in most cases by an active search for the duodenum during surgical procedures that require Kocherization. As soon as the ascending colon is reflected, the surgeon should begin an active search for the duodenum. While usually quite distinct, the duodenum can be decompressed and difficult to discern. Active searching for the duodenum increases the likelihood of identification without damaging this sensitive structure.

Hepatic and splenic injury may result from Veress needle passage, initial trocar insertion, or an unmonitored auxiliary instrument.

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