Managing Bowel Injuries in Laparoscopic Surgery: Real Cases, Real Solutions – ARC Summit
Bowel injuries in laparoscopy are severe complications, typically not resulting from Veress needle insertion but rather from delayed manifestations, such as thermal injury, becoming apparent days later. Symptoms like sharp abdominal pain and vomiting are critical indicators and should be immediately investigated as potential bowel injuries until proven otherwise. Bowel preparation is generally unhelpful for these patients unless bowel resections are anticipated.
For small bowel injuries, signs include elevated white blood cell counts and a significant drop in glucose levels. C-reactive protein is a valuable diagnostic tool; a value over 100 suggests a potential bowel injury. These cases do not benefit from antibiotics but require prompt surgical intervention, which is often delayed by clinicians to the detriment of the patient. A study by Bronson in Europe showed that while minor laparoscopic procedures have a low incidence of bowel injuries, major surgeries have a higher risk. Experienced surgeons tend to have fewer complications.
In 1995, we encountered a bowel injury during a procedure on a woman who had previously had a C-section. During the operation, I noticed something unusual after removing an ovary. The nursing team alerted me to a green substance leaking from the trocar. It turned out to be bowel content, leading to an emergency situation that required an extensive operation by general surgeons to repair.
Another incident involved a resident accidentally causing a bowel injury during a hysterectomy. We recognized the injury immediately, managed to complete the hysterectomy, and then had to perform an extensive repair. Unfortunately, the trauma team, unfamiliar with laparoscopic procedures, insisted on converting to an open surgery for a simple suture that could have been done laparoscopically.
These experiences underscore the critical nature of immediate recognition and management of bowel injuries in laparoscopy. Surgeons must be vigilant, prepared to react swiftly, and possess the skills necessary to address complications directly or involve appropriate specialists without delay. Proper training, experience, and adherence to surgical best practices are essential to prevent such severe complications and ensure patient safety.
