Bowel injury as a complication of laparoscopy.
BACKGROUND
Bowel injury is a rare but serious complication of laparoscopic surgery. This review examines the incidence, location, time of diagnosis, causative instruments, management and mortality of laparoscopy-induced bowel injury.


METHODS
The review was carried out using the MeSH browser within PubMed. The keywords used were 'laparoscopy/adverse effects' and 'bowel perforation'. Additional articles were sourced from references within the studies found in the PubMed search.


RESULTS
The incidence of laparoscopy-induced gastrointestinal injury was 0.13 per cent (430 of 329 935) and of bowel perforation 0.22 per cent (66 of 29 532). The small intestine was most frequently injured (55.8 per cent), followed by the large intestine (38.6 per cent). In at least 66.8 per cent of bowel injuries the diagnosis was made during the laparoscopy or within 24 h thereafter. A trocar or Veress needle caused the most bowel injuries (41.8 per cent), followed by a coagulator or laser (25.6 per cent). In 68.9 per cent of instances of bowel injury, adhesions or a previous laparotomy were noted. Management was mainly by laparotomy (78.6 per cent). The mortality rate associated with laparoscopy-induced bowel injury was 3.6 per cent.


CONCLUSIONS
At 0.13 per cent, the incidence of laparoscopy-induced bowel injury is small and such injury is usually discovered during the operation. Nevertheless, laparoscopy-induced bowel injury is associated with a high mortality rate of 3.6 per cent.
van der Voort
M
M
Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Heijnsdijk
E A M
EA
Gouma
D J
DJ
D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology*; D007420:Intestine, Large / Q000293:injuries*; D007421:Intestine, Small / Q000293:injuries*; D010535:Laparoscopy / Q000009:adverse effects*; D013270:Stomach / Q000293:injuries*; D013525:Surgical Instruments; D000267:Tissue Adhesions / Q000209:etiology