title: Operative management of rectal injuries during laparoscopic radical prostatectomy.
abstract: OBJECTIVE
  To present our experience in the management of rectal injuries during laparoscopic radical prostatectomy.
  
  
  METHODS
  All patients underwent bowel preparation and received perioperative antibiotics. If rectal injury was suspected, digital rectal examination was performed, aided by bubbling air into the rectum if required. When the diagnosis was confirmed, the hole was closed in two layers of absorbable sutures. A fat flap was developed from the omentum (in the transperitoneal approach) or the perirectal fat (in the extraperitoneal approach) and placed on the suture line. Anal dilation was performed. After surgery, broad-spectrum antibiotics and a low-residue diet were prescribed.
  
  
  RESULTS
  Of 300 patients who underwent surgery between May 1998 and June 2002, 6 (2%) had a rectal injury. The first patient had received neoadjuvant hormonal therapy. Five cases were in the transperitoneal approach and were closed using omental fat and 1 was in the extraperitoneal approach with a perirectal fat flap. The first patient presented with a rectourethral fistula and was treated with catheterization for 1 month and a diverting colostomy. The others were detected intraoperatively and were treated laparoscopically. In the second patient, a diverting colostomy was performed at the end of surgery using a separate incision. Patients resumed oral intake within 2 to 7 days and were discharged from the hospital between 6 and 18 days postoperatively. No wound infection was noted.
  
  
  CONCLUSIONS
  Rectal injuries during laparoscopic radical prostatectomy can be identified and managed intraoperatively without requiring conversion. Double-layered closure reinforced by a fat flap resulted in an uneventful recovery.
authors.affiliation: Department of Urology, CHU Henri Mondor, Cretéil, France.
authors.forename: Ran
authors.initials: R
authors.lastname: Katz
authors.forename: Tomasz
authors.initials: T
authors.lastname: Borkowski
authors.forename: Andras
authors.initials: A
authors.lastname: Hoznek
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.forename: Alexandre
authors.initials: A
authors.lastname: de la Taille
authors.forename: Clement Claude
authors.initials: CC
authors.lastname: Abbou
mesh_terms: D003125:Colostomy; D004106:Dilatation; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D007902:Length of Stay; D008297:Male; D009852:Omentum / Q000637:transplantation; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery; D012007:Rectum / Q000293:injuries* / Q000601:surgery*; D013524:Surgical Flaps; D013536:Suture Techniques; D013997:Time Factors; D017211:Treatment Failure; D014525:Urethral Stricture / Q000209:etiology / Q000601:surgery