Laparoscopic Bowel Injury

Laparoscopic bowel injuries are a rare but potentially fatal complication, especially if initial recognition is delayed. Presentation is often atypical when compared with open surgery. Aldana and colleagues looked at laparoscopic bowel injury in a rabbit model using serum monocyte, neutrophil, and lymphocyte apoptosis as indicators of the immune response. They observed that open surgery resulted in a significant increase in programmed cell death compared with controls in the immediate postoperative period following bowel injury. In comparison, laparoscopic bowel injury resulted in a delayed response that only approached open surgery levels after two weeks. They concluded that this difference in degree of cellular death could be secondary to a smaller degree of stimulation of the immune response in laparoscopic surgery. When the period of laparoscopy was extended from one to five hours, the percentage of apoptosis was similar to that seen after open surgery and no animal undergoing a five-hour procedure survived to two weeks after bowel injury (84).

It is well recognized that patients with laparoscopic bowel injury following urological procedures do not present with the typical acute surgical abdomen.

Bishoff et al. reported bowel perforation in 0.2% and bowel abrasion in 0.6% of cases. The latter were recognized and repaired at the time of injury but the patients with perforation presented postoperatively with single port site pain, abdominal distention, diarrhea, leukopenia, followed by cardiopulmonary collapse secondary to sepsis within 96 hours of surgery. These can be fatal injuries and it is important to recognize the initial unusual signs and reduction in leukocyte count (85). The overall incidence of bowel injury is 1.3/1000, most of which are unrecognized intraoperatively and need laparotomy to repair the injuries.

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