[Bowel injuries after port insertion in laparoscopy. Gynerisq's database analysis].
BACKGROUND
Port insertion is a high-risk period during laparoscopy. The French Gynecologist and Obstetricians College (CNGOF) published recommendations in 2010 to minimize those risks. The aim of our analysis was to establish the accidents' circumstances and consequences and to determine if those incidents could have been depending on whether recommendations had been respected or not.


METHODS
Gynerisq is an approved organism by the Haute Autorité de santé (HAS). Its mission is to evaluate and improve practices by a risk management centered approach. We analysed incidents reported by Gynerisq's adherents in an experience report database.


RESULTS
Above 114 incidents analysed in the Gynerisq's database, we reported 31 bowel injuries. Those injuries occurred for 77.4% (24/31) during planned interventions. For 32.3% of the cases (10/31), interventions were judged complex by the surgeons. A total of 54.8% (17/31) of the patients had a history of laparotomy. Above 27 injuries occurred during Veress needle or open laparoscopy, 17 could have been avoided regarding to the surgeon. The causes reported were in 10 cases that the recommendations had not been respected, in 2 cases another cause and in 5 cases no causes were given to explain the incident.


CONCLUSIONS
Our analysis shows that bowel injuries after port insertion, in open laparoscopy or Veress needle use, do not seem to occur only in an emergency context or during complicated interventions. However, most of the incidents occurred for patients with risk factors.
Service de gynécologie obstétrique, hôpital la Conception, 147, boulevard Baille, 13005 Marseille, France.
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E
Cesario
Service de gynécologie obstétrique, hôpital la Conception, 147, boulevard Baille, 13005 Marseille, France.
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P
Crochet
Polyclinique Saint-Claude, boulevard docteur Schweitzer, 02100 Saint-Quentin, France.
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FX
Boyer de Latour
Clinique Champeau, 34535 Béziers cedex, France.
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Eglin
Hôpital privé de Marne-Chantereine, rue Curie, 77177 Brou-sur-Chantereine, France.
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De Rochambeau
Service de gynécologie obstétrique, hôpital la Conception, 147, boulevard Baille, 13005 Marseille, France. Electronic address: aubert.agostini@ap-hm.fr.
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Agostini
D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007420:Intestine, Large / Q000293:injuries*; D010535:Laparoscopy / Q000009:adverse effects* / Q000706:statistics & numerical data*; D008875:Middle Aged; D055815:Young Adult
Bowel injury; Cœlioscopie; Laparoscopy; Plaie digestive; Port; Trocart cœlioscopie