Bowel injury following gynecological laparoscopic surgery.

Hassan M Elbiss1, Fikri M Abu-Zidan2
1. Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, UAE University,
17666 Al-Ain, United Arab Emirates. Email: helbiss@uaeu.ac.ae
2. Department of Surgery, College of Medicine and Health Sciences, UAE University,17666 Al-Ain, United
Arab Emirates. Email: fabuzidan@uaeu.ac.ae

Abstract
Background: Bowel injury remains a serious complication of gynecological laparoscopic surgery. We aimed to review the
literature on this topic, combined with personal experiences, so as to give recommendations on how to avoid and manage this
complication.

Methods: We performed a narrative review on bowel injury following gynecological laparoscopic surgery using PubMed covering prevention, diagnosis, and management. Search terms used were laparoscopy, gynaecology, injury, bowel, prevention, treatment.

Results: Important principles of prevention include proper pre-operative evaluation and increased laparoscopic surgical skills
and knowledge. High clinical suspicion is crucial for early diagnosis. Diagnostic workup of suspected cases includes serial abdominal examination, measuring inflammatory markers, and performing imaging studies including abdominal ultrasound and CT scan. When bowel injury is recognized during the frst laparoscopic procedure then laparoscopic primary suturing could be tried although laparotomy may be needed. When diagnosis is delayed, then laparotomy is the treatment of choice. The role of robotic surgery and three-dimensional laparoscopic gynecological surgery on bowel injury needs to be further assessed.

Conclusion: Early recognition of bowel injury is crucial for a favorable clinical outcome. A combined collaboration between
gynecologists and general surgeons is important for timely and proper decisions to be made.

Keywords: Laparoscopy, gynaecology, injury, bowel, prevention, treatment.