The role of intraoperative proctosigmoidoscopy in laparoscopic pelvic surgery.
OBJECTIVE
To report the outcome of rigid sigmoidoscopy during operative laparoscopy in patients at high risk for rectosigmoid and large bowel injury.


METHODS
Prospective patient database with retrospective chart review (Canadian Task Force classification II-3).


METHODS
Referral practice and tertiary medical center.


METHODS
Two hundred sixty-two women with rectosigmoid endometriosis and adhesions.


METHODS
Rigid sigmoidoscopy during laparoscopy. At the end of surgery, proctosigmoidoscopy was performed to evaluate intraluminal abnormality or rectosigmoid injury. The pelvis was then filled with isotonic fluid to observe laparoscopically for air leakage.


RESULTS
Sigmoidoscopy was performed due to a lesion involving the rectum or sigmoid in 60.7%, large bowel in 11.1%, and posterior cul-de-sac in 28.2% of patients. During laparoscopy, endometriosis was found in 30.5%, adhesions in 20.2%, and both in 43.5%. Four women (1.5%) had bowel injury identified during sigmoidoscopy; all bowel injuries were treated by intracorporeal laparoscopic suturing. One incomplete repair was detected by sigmoidoscopy. In one woman (0.4%) a rectal polyp was detected.


CONCLUSIONS
Bowel injury is one of the most serious complications of laparoscopy. Early detection and prompt intraoperative management are essential to prevent a potentially catastrophic outcome. Sigmoidoscopy is a relatively easy procedure and aids during laparoscopy in the diagnosis of bowel perforation and in assessment of bowel wall invasion and potential stricture caused by endometriosis. It is a safe procedure even when performed immediately after extensive laparoscopic surgical treatment of rectosigmoid endometriosis and adhesions.
Nezhat
Ceana
C
Center for Special Pelvic Surgery, Atlanta, Georgia, USA.
Seidman
Daniel
D
Nezhat
Farr
F
Nezhat
Camran
C
D000328:Adult; D004715:Endometriosis / Q000601:surgery; D005260:Female; D006801:Humans; D007422:Intestines / Q000293:injuries; D007431:Intraoperative Complications / Q000175:diagnosis*; D010535:Laparoscopy; D008875:Middle Aged; D010388:Pelvis / Q000601:surgery*; D012002:Rectal Diseases / Q000601:surgery; D012810:Sigmoid Diseases / Q000601:surgery; D012812:Sigmoidoscopy; D000267:Tissue Adhesions / Q000601:surgery