The role of proctosigmoidoscopy in laparoscopic pelvic surgery

Objective: To evaluate the efficiency and safety of rigid sigmoidoscopy during operative laparoscopy in patients at high risk for rectosigmoid and large bowel disease or injury. Methods: We conducted a prospective study of 262 women treated for rectosigmoid endometriosis and adhesions at the Center for Special Pelvic Surgery in Atlanta, Georgia. All of the subjects underwent a rigid sigmoidoscopy during laparoscopy. At the end of surgery, proctosigmoidoscopy was performed for the evaluation of any intraluminal abnormality or rectosigmoid injury. The pelvis was then filled with isotonic fluid to observe laparoscopically any air leakage. Results: Sigmoidoscopy was indicated due to a lesion involving the rectum or sigmoid in 60.7%, the large bowel in 11.1%, and the posterior cul-de-sac in 28.2% of the cases. The primary indication for surgery was pelvic pain, endometriosis, or adhesions in 88.6%. During laparoscopy, endometriosis was found in 30.5%, adhesions in 20.2%, and both in 43.5%. Intentional or unintentional bowel perforation occurred in 44 (16.8%) patients. In four (1.5%) patients, the bowel injury was identified during sigmoidoscopy. All participants were treated by intracorporeal laparoscopic suturing. One incomplete repair was detected by sigmoidoscopy. In 1 (0.4%) case, a rectal polyp was detected. Conclusions: Bowel injury is recognized as one of the most serious complications of laparoscopy. Early recognition and prompt intraoperative management are essential to prevent a potentially catastrophic outcome. Sigmoidoscopy is a relatively easy procedure during laparoscopy and aids in the diagnosis of bowel perforation and in assessment of bowel wall invasion and any potential stricture caused by endometriosis. It is a safe procedure, even when performed immediately after extensive laparoscopic surgical treatment of rectosigmoid endometriosis and adhesions. Sigmoidoscopy may be used with discretion as a diagnostic and risk management tool during laparoscopic surgery of the rectosigmoid colon.