Laparoscopic bowel injury: role of the site and the instrument type: study with an animal model.
BACKGROUND
Unrecognized laparoscopic bowel injuries are complications that can occur during any laparoscopic procedure. These complications have variable morbidity and mortality rates, and their early clinical signs of inflammation are not typical. Therefore, a study was planned to predict the mechanical behavior of the injured bowel, taking into consideration two parameters: the size of the instrument and the site of the injury.


METHODS
For this study, 78 Wistar rats were divided into eight study groups and one control group with two subgroups. Bowel injury was created using different sizes of needles and electrocautery on two different bowel sites: the jejunum and the terminal ileum. The animals were killed 48 h after surgery, followed by harvesting of the injured part of the bowel and measurement of the intraluminal pressure at which the bowel ruptured.


RESULTS
The mean jejunum and terminal ileum rupture pressures on the injured bowel were significantly lower than on the intact bowel. The mean terminal ileum rupture pressures were significantly lower than those of the jejunum.


CONCLUSIONS
The terminal ileum appears to be more fragile than the jejunum regardless of the size of the instrument that caused the injury. However, wider instrument tips cause more serious consequences.
Tsigris
C
C
First Department of Surgery, Athens University, Laiko General Hospital, 17 Ag. Thoma st., 11527 Athens, Greece. ctsigris@med.uoa.gr
Tsechpenakis
A
A
Nikiteas
N
N
Tzogios
I
I
Vlachos
I S
IS
Diamantis
Th
T
Perrea
D N
DN
D000818:Animals; D004867:Equipment Design; D005260:Female; D007422:Intestines / Q000293:injuries*; D020706:Laparoscopes / Q000009:adverse effects*; D010535:Laparoscopy / Q000009:adverse effects*; D023421:Models, Animal; D011312:Pressure; D051381:Rats; D017208:Rats, Wistar